老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建

杨昌凤; 何永琴; 易德坤; 李玉; 赖淋雨; 张玉梅

doi:10.16016/j.2097-0927.202209135

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老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建

临床医学 | 更新时间：2026-01-09

- 老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建
- Influencing factors of 1-year postoperative mortality in elderly with hip fracture and construction of a nomogram prediction model
- 陆军军医大学学报 2023年45卷第1期页码：60-66
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院骨科
- 作者简介：
  
  [ 张玉梅，E-mail：zhangyumei19693@sina.com ZHANG Yumei, E-mail: zhangyumei19693@sina.com
- 基金信息：
  
  陆军军医大学护理创新基金项目(2020m09)
- DOI：10.16016/j.2097-0927.202209135
  中图分类号： R195.4;R339.34;R683.3
- 收稿：2022-09-15，
  
  修回：2022-11-16，
  
  纸质出版：2023-01-15
- 稿件说明：
移动端阅览
杨昌凤, 何永琴, 易德坤, 等. 老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建[J]. 陆军军医大学学报, 2023,45(1):60-66.

Changfeng YANG, Yongqin HE, Dekun YI, et al. Influencing factors of 1-year postoperative mortality in elderly with hip fracture and construction of a nomogram prediction model[J]. Journal of Army Medical University, 2023, 45(1): 60-66.
杨昌凤, 何永琴, 易德坤, 等. 老年髋部骨折患者术后1年内死亡的影响因素分析及列线图预测模型构建[J]. 陆军军医大学学报, 2023,45(1):60-66. DOI： 10.16016/j.2097-0927.202209135.

Changfeng YANG, Yongqin HE, Dekun YI, et al. Influencing factors of 1-year postoperative mortality in elderly with hip fracture and construction of a nomogram prediction model[J]. Journal of Army Medical University, 2023, 45(1): 60-66. DOI： 10.16016/j.2097-0927.202209135.

摘要

目的

探讨基于营养学新评价指标的老年髋部骨折患者术后1年死亡的影响因素，并根据危险因素绘制列线图，预测老年髋部骨折患者1年死亡风险。

方法

回顾性分析2018年1月至2021年5月行手术治疗且获得随访的457例老年髋部骨折患者，记录患者基线资料、MNA评分、NRS2002评分、APACHE Ⅱ评分、血清营养学指标、人体成分分析指标等营养学新评价指标资料，以1年内死亡为观察结局。采用多因素Logistic回归模型分析老年髋部骨折患者术后1年内死亡的独立危险因素，进一步采用R Studio软件构建预测老年髋部骨折患者术后1年死亡风险的列线图模型。

结果

术后1年内共52例患者死亡，病死率为11.38%。共存疾病≥3种、年龄、CRP水平是老年髋部骨折患者术后1年内死亡的独立危险因素[

及95%

分别为3.196(1.107~9.226)、1.152(1.083~1.225)、1.013(1.004~1.022)，

0.05

]

，BMI、骨骼肌含量是保护因素[

及95%

分别为0.766(0.671~0.874)和0.782(0.726~0.842)，

0.05

]

；基于以

上5个影响因素绘制列线图，并进行内部验证，结果显示模型区分度C-index指数及95%

分别为0.92(0.870~0.970)，校正曲线提示模型一致性良好，说明列线图模型具有较好的预测能力。

结论

年龄、CRP、BMI、共存疾病≥3种、骨骼肌含量是老年髋部骨折患者术后1年死亡的独立影响因素。列线图模型对预测老年髋部骨折患者术后1年死亡风险具有一定作用。

Abstract

Objective

To investigate the influencing factors of 1-year postoperative mortality in elderly patients with hip fracture based on new nutritional indicators

and draw a predictive nomogram for 1-year death in these elderly patients.

Methods

A retrospective study was conducted on 457 elderly hip fracture patients who underwent surgical treatment in our department from January 2018 to May 2021. All of them were followed up

and the outcomes in 1 year after operation were observed. Their baseline data

mini-nutritional assessment (MNA) score

nutritional risk screening 2002 (NRS2002) score

acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score

serum nutritional indicators

body compositions and other new nutritional indicators were collected and analysis with 1-year mortality as observation outcome. Multivariate logistic regression analysis was used to analyze the independent risk factors of 1-year postoperative death in these elderly patients

and further R Studio software was applied to build a nomograph model to predict the risk of death.

Results

Of 457 elderly patients with hip fracture

52 (11.38%) died within 1 year after operation and 405 survived. More than 3 comorbidities

age

and C-reactive protein (CRP) level were independent risk factors [

(95%

): 3.196(1.107~9.226)

1.152(1.083~1.225)

1.013(1.004~1.022)

0.05

]

and BMI and skeletal muscle content were protective factors [

(95%

): 0.766(0.671~0.874)

0.782(0.726~0.842)

0.05

]

for death within 1 year after surgery in elderly pati

ents with hip fracture. Based on the above 5 influencing factors

a column graph was drawn and assessed with internal verification. The results showed that the C-index of model differentiation and 95%

was 0.92 and 0.870~0.970

respectively. The correction curve indicated that the model had good consistency

indicating that the column graph model had good predictive ability.

Conclusion

Age

CRP

BMI

≥3 comorbidities and skeletal muscle content are independent risk factors for death within 1 year after hip fracture in elderly patients. The nomogram model has a certain effect on predicting the 1-year mortality risk in them.

关键词

Keywords

references

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