Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
Int Urol Nephrol. 2021 Nov;53(11):2359-2367. doi: 10.1007/s11255-021-02798-7. Epub 2021 Mar 8.
People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD.
Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD.
397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11-2.98) and 3.11 (95% Cl 2.47-3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84-0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87-1.00).
Patients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.
与无 CKD 个体相比，患有慢性肾脏病（CKD）的患者发生髋部骨折的风险更高，且与之相关的死亡率风险也更高。本研究旨在评估用于预测 CKD 患者髋部骨折后死亡率风险的最佳临床评估工具。
纳入 2013 年 6 月至 2019 年 12 月期间在英国兰开夏教学医院 NHS 基金会信托基金就诊的 CKD G3b-5D 患者。评估 CKD 与骨折后死亡率风险之间的关系。所有患者均使用评估虚弱状态、合并症、术前风险、功能状态和心肺健康状况的工具进行评估。进行受试者工作特征曲线分析，以确定评估工具在预测 CKD 患者髋部骨折后 30 天和 1 年死亡率方面的准确性。
397 例患者符合纳入标准，平均年龄为 83.5±9.2 岁。年龄较大、女性、囊内骨折以及 CKD 更严重、合并症和虚弱状态与死亡率风险增加相关。接受透析依赖型 CKD 治疗和严重/极严重虚弱的患者，其死亡率的危险比分别为 2.55（95%置信区间 2.11-2.98）和 3.11（95%置信区间 2.47-3.93）。临床虚弱量表在预测 30 天（曲线下面积（AUC）0.91，95%置信区间 0.84-0.97）和 1 年死亡率（AUC 0.93，95%置信区间 0.87-1.00）方面均具有最佳的预后准确性。
患有晚期 CKD 和严重虚弱的患者髋部骨折后死亡率风险较高。临床虚弱量表是该人群中死亡率的优秀预后工具，可轻松纳入常规临床实践。
