老年髋部骨折术后半年死亡风险预测列线图模型构建  

Construction of a nomogram model for predicting the mortality risk within half a year after hip fracture surgery in the elderly

作　　者：刘亚飞 白晶晶 龚福太 Liu Yafei;Bai Jingjing;Gong Futai(Bone Microrepair Surgery,Xi'an Honghui Hospital,Shaanxi Orthopaedic Hospital,Xi'an 710054,China;Spinal Disease Ward,Xi'an Hospital of Traditional Chinese Medicine,Xi'an 710016,China)

机构地区：[1]西安市红会医院陕西省骨科医院骨显微修复外科,西安710054 [2]西安市中医医院脊柱病区,西安710016

出　　处：《国际医药卫生导报》2024年第24期4154-4159,共6页International Medicine and Health Guidance News

基　　金：陕西省科技厅科技计划项目(2021QFY01-05)。

摘　　要：目的分析老年髋部骨折术后半年死亡的影响因素并构建个体化预测列线图模型。方法回顾性分析西安市红会医院2020年5月至2022年8月行手术治疗的458例老年髋部骨折患者的临床资料,其中男214例、女244例,年龄65~94(75.89±7.72)岁。根据术后半年内是否存活分为死亡组(43例)和存活组(415例)。收集两组临床资料,采用多因素logistic回归分析老年髋部骨折术后半年死亡的影响因素;采用R软件绘制列线图模型,并通过校准曲线验证列线图模型的一致性,采用受试者操作特征曲线(ROC)评估模型预测价值及区分度。采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验进行统计学分析。结果老年髋部骨折患者术后半年死亡率为9.39%(43/458)。多因素logistic回归分析显示,年龄(OR=1.167,95%CI:1.088~1.250)、合并症种类(OR=1.986,95%CI:1.143~3.452)为老年髋部骨折术后半年死亡的危险因素,骨骼肌含量(OR=0.814,95%CI:0.715~0.925)、血红蛋白(OR=0.923,95%CI:0.868~0.981)为保护因素(均P<0.05)。构建的列线图模型预测老年髋部骨折术后半年死亡的曲线下面积为0.899(95%CI:0.888~0.923),区分度较好。列线图模型预测老年髋部骨折术后半年死亡的校准曲线斜率趋近于1,且Hosmer-Lemeshow拟合优度检验χ^(2)=4.091,P=0.849,一致性较好。结论本研究基于年龄、合并症种类、骨骼肌含量、血红蛋白4项影响因素构建预测老年髋部骨折术后半年死亡风险的列线图模型,区分度及一致性较好,能够为临床制定个体化干预措施提供参考依据。Objective To analyze the influencing factors of death within half a year after hip fracture surgery in the elderly and construct an individualized prediction nomogram model.Methods The clinical data of 458 elderly patients with hip fracture who underwent surgical treatment in Xi'an Honghui Hospital from May 2020 to August 2022 were retrospectively analyzed,including 214 males and 244 females,aged 65-94(75.89±7.72)years.The patients were divided into a death group(43 cases)and a survival group(415 cases)according to whether they survived within half a year after surgery.The clinical data of the two groups were collected,and the influencing factors of death within half a year after hip fracture surgery were analyzed by multivariate logistic regression analysis.R software was used to draw the nomogram model,and the consistency of the nomogram model was verified by the calibration curve.The receiver operating characteristic curve(ROC)was used to evaluate the prediction value and discrimination of the model.Independent sample t test,Mann-Whitney U test,and χ^(2) test were used for statistical analysis.Results The mortality rate of elderly patients within half a year after hip fracture surgery was 9.39%(43/458).Multivariate logistic regression analysis showed that age(OR=1.167,95%CI:1.088-1.250)and type of comorbidities(OR=1.986,95%CI:1.143-3.452)were risk factors for death within half a year after hip fracture surgery in elderly patients,and skeletal muscle content(OR=0.814,95%CI:0.715-0.925)and hemoglobin(OR=0.923,95%CI:0.868-0.981)were protective factors(all P<0.05).The area under the curve was 0.899(95%CI:0.888-0.923)of the nomogram model in the prediction of death within half a year after hip fracture surgery in elderly patients,with good discrimination.The slope of calibration curve of the nomogram model for the prediction of death within half a year after hip fracture surgery in elderly patients was close to 1,and the Hosmer-Lemeshow goodness-fit test showed good consistency(χ^(2)=4.091,P=0.849).Conclusions T

关 键 词：髋部骨折 老年 术后半年 死亡 影响因素 列线图 

分 类 号：R687.3[医药卫生—骨科学]