Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, NSW, Australia.
Bone. 2011 Sep;49(3):553-8. doi: 10.1016/j.bone.2011.06.002. Epub 2011 Jun 13.
Approximately 10% of hip fracture patients die during hospitalization; however, it is not clear what risk factors contribute to the excess mortality. This study sought to examine risk factors of, and to develop prognostic model for, predicting in-hospital mortality among hip fracture patients.
We studied outcomes among 410 men and 1094 women with a hip fracture who were admitted to a major-teaching-hospital in Sydney (Australia) between 1997 and 2007. Clinical data, including concomitant illnesses, were obtained from inpatient data. The primary outcome of the study was in-hospital mortality regardless of length of stay. A Log-binomial regression model was used to identify risk factors for in-hospital mortality. Using the identified risk factors, prognostic nomograms were developed for predicting short term risk of mortality for an individual.
The median duration of hospitalization was 9 days. During hospitalization, the risk of mortality was higher in men (9%) than in women (4%). After adjusting for multiple risk factors, increased risk of in-hospital mortality was associated with advancing age (rate ratio [RR] for each 10-year increase in age: 1.91 95% confidence interval [CI]: 1.47 to 2.49), in men (RR 2.13; 95% CI 1.41 to 3.22), and the presence of comorbid conditions on admission (RR for one or more comorbid conditions vs. none: 2.30; 95% CI 1.52 to 3.48). Specifically, the risk of mortality was increased in patients with a pre-existing congestive heart failure (RR 3.02; 95% CI: 1.65 to 5.54), and liver disease (RR 4.75; 95% CI: 1.87 to 12.1). These factors collectively accounted for 69% of the risk for in-hospital mortality. A nomogram was developed from these risk factors to individualize the risk of in-hospital death following a hip fracture. The area under the receiver operating characteristic curve of the final model containing age, sex and comorbid conditions was 0.76.
These data suggest that among hip fracture patients, advancing age, gender (men), and pre-existing concomitant diseases such as congestive heart failure and liver disease were the main risk factors for in-hospital mortality. The nomogram developed from this study can be used to convey useful prognostic information to help guide treatment decisions.
约有 10%的髋部骨折患者在住院期间死亡；然而，目前尚不清楚哪些危险因素导致了过高的死亡率。本研究旨在探讨髋部骨折患者住院期间死亡的危险因素，并建立预测模型。
我们研究了 1997 年至 2007 年间在悉尼一家主要教学医院住院的 410 名男性和 1094 名女性髋部骨折患者的结局。临床数据，包括合并症，从住院数据中获得。该研究的主要结局是无论住院时间长短，住院期间的死亡率。使用 Log-binomial 回归模型确定住院期间死亡率的危险因素。使用确定的危险因素，为个体预测短期死亡率风险开发了预后列线图。
中位住院时间为 9 天。住院期间，男性（9%）的死亡率高于女性（4%）。在调整了多个危险因素后，住院期间死亡率的增加与年龄的增加有关（每增加 10 岁的风险比 [RR]：1.91；95%置信区间 [CI]：1.47 至 2.49），在男性中（RR 2.13；95% CI 1.41 至 3.22），以及入院时存在合并症（RR 为一个或多个合并症与无合并症相比：2.30；95% CI 1.52 至 3.48）。具体而言，患有预先存在的充血性心力衰竭（RR 3.02；95% CI：1.65 至 5.54）和肝脏疾病（RR 4.75；95% CI：1.87 至 12.1）的患者死亡风险增加。这些因素共同解释了住院期间死亡率的 69%。从这些危险因素中开发了一个列线图，以针对个体髋部骨折后的住院死亡风险。包含年龄、性别和合并症的最终模型的接收者操作特征曲线下面积为 0.76。
这些数据表明，在髋部骨折患者中，年龄的增长、性别（男性）以及充血性心力衰竭和肝脏疾病等预先存在的合并症是住院期间死亡的主要危险因素。从本研究中开发的列线图可以用来提供有用的预后信息，以帮助指导治疗决策。
