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IF 1.9 3区医学 Q2 EMERGENCY MEDICINE

European Journal of Trauma and Emergency Surgery Pub Date : 2025-03-20 DOI:10.1007/s00068-025-02812-y

Mads Sundet, Mette Martinsen, Maren Paus, Haldor Valland, Henriette Haugeli Halvorsen, Joseph Sexton, Ulf Sundin, Siri Lillegraven

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引用次数: 0

摘要

目的：了解与髋部骨折后死亡率相关的因素对于分析和临床都很重要。本研究旨在评估大型临床队列中预测1年死亡率的患者风险因素和常用综合评分。方法：髋部骨折患者的数据被前瞻性地记录在当地医院的数据库中，其中包括 2006 年至 2020 年间连续发生的骨折，5496 名患者中的 6040 例骨折。采用单变量和两个多变量逻辑回归模型估算了1年死亡率与不同暴露因素之间的关系。使用ROC分析比较了诺丁汉髋部骨折评分（NHFS）、年龄调整后的夏尔森合并症指数（ACCI）、美国麻醉医师协会评分（ASA）和骨科虚弱评分（OFS）预测1年死亡率的能力：结果：73.9%的骨折是女性造成的。1年总死亡率为24.8%。超重和1级肥胖患者的1年死亡率低于正常体重患者[超重：调整后OR为0.58（0.45-0.77），1级肥胖：调整后OR为0.40（0.21-0.75）]。男性（调整 OR 2.04，95% CI 1.76-2.36）和疗养院居民（调整 OR 2.99，95% CI 2.60-3.44）的死亡率较高。我们发现手术前等待时间与死亡率之间没有明显的关联。包括ACCI（AUC 0.74）、NHFS（AUC 0.75）和OFS（AUC 0.73）在内的模型预测1年死亡率的能力相似，而包括ASA（AUC 0.71）在内的模型预测能力明显低于ACCI和NHFS：结论：性别、年龄、认知障碍和居住状况可预测 1 年死亡率。研究发现了一个明显的 "肥胖悖论"，即超重患者的死亡率低于正常体重患者，但未测量的混杂因素可能会使这一分析产生偏差。ACCI和NHFS对死亡率的预测优于年龄、性别和ASA的组合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Predictors of 1-year mortality in a clinical cohort of hip fracture patients.

Purpose: Knowledge about factors associated with mortality after hip fracture is important both for analytical and clinical purposes. This study aimed to assess patient risk factors and commonly used composite scores for prediction of 1-year mortality in a large clinical cohort.

Methods: Hip fracture patient data were prospectively recorded in a local hospital database. Consecutive fractures from 2006 to 2020 were included, 6040 fractures in 5496 patients. Associations between 1-year mortality and different exposures were estimated using univariate and two multivariate logistic regression models. ROC analysis was used to compare the ability of the Nottingham Hip Fracture Score (NHFS), Age-adjusted Charlson Comorbidity Index (ACCI) the American Society of Anesthesiologists score (ASA) and the Orthopedic Frailty Score (OFS) to predict 1-year mortality.

Results: Females sustained 73.9% of the fractures. Total 1-year mortality was 24.8%. Patients with overweight and class 1 obesity had lower 1-year mortality rates than normal weight patients [overweight: adjusted OR 0.58 (0.45-0.77), class 1 obesity: adjusted OR 0.40 (0.21-0.75)]. Mortality was elevated in males (adjusted OR 2.04, 95% CI 1.76-2.36), and nursing home residents (adjusted OR 2.99, 95% CI 2.60-3.44). We found no significant association between waiting time before surgery and mortality. Models including ACCI (AUC 0.74), NHFS (AUC 0.75) and OFS (AUC 0.73) had a similar ability to predict 1-year mortality, while a model including ASA (AUC 0.71) had a significantly lower prediction ability than ACCI and NHFS.

Conclusions: Sex, age, cognitive impairment, and residential status predicted 1-year mortality. The study found an apparent "obesity paradox", where overweight patients had a lower mortality rate than normal weight patients, but unmeasured confounding may have biased this analysis. ACCI and NHFS predicted mortality better than the combination of age, sex, and ASA.

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来源期刊

European Journal of Trauma and Emergency Surgery 医学-急救医学

CiteScore

4.50

自引率

14.30%

发文量

311

审稿时长

3 months

期刊介绍： The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.