Ohata Emi, Nakatani Eiji, Kaneda Hideaki, Fujimoto Yoh, Tanaka Kiyoshi, Takagi Akira
Graduate School of Public Health Shizuoka Graduate University of Public Health Shizuoka Japan.
4DIN Ltd Tokyo Japan.
JBMR Plus. 2023 Apr 5;7(6):e10743. doi: 10.1002/jbm4.10743. eCollection 2023 Jun.
Hip fractures are common in patients of advanced age and are associated with excess mortality. Rapid and accurate prediction of the prognosis using information that can be easily obtained before surgery would be advantageous to clinical management. We performed a population-based retrospective cohort study using an 8.5-year Japanese claims database (April 2012-September 2020) to develop and validate a predictive model for long-term mortality after hip fracture. The study included 43,529 patients (34,499 [79.3%] women) aged ≥65 years with first-onset hip fracture. During the observation period, 43% of the patients died. Cox regression analysis identified the following prognostic predictors: sex, age, fracture site, nursing care certification, and several comorbidities (any malignancy, renal disease, congestive heart failure, chronic pulmonary disease, liver disease, metastatic solid tumor, and deficiency anemia). We then developed a scoring system called the Shizuoka Hip Fracture Prognostic Score (SHiPS); this system was established by scoring based on each hazard ratio and classifying the degree of mortality risk into four categories based on decision tree analysis. The area under the receiver operating characteristic (ROC) curve (AUC) (95% confidence interval [CI]) of 1-year, 3-year, and 5-year mortality based on the SHiPS was 0.718 (95% CI, 0.706-0.729), 0.736 (95% CI, 0.728-0.745), and 0.758 (95% CI, 0.747-0.769), respectively, indicating good predictive performance of the SHiPS for as long as 5 years after fracture onset. Even when the SHiPS was individually applied to patients with or without surgery after fracture, the prediction performance by the AUC was >0.7. These results indicate that the SHiPS can predict long-term mortality using preoperative information regardless of whether surgery is performed after hip fracture.
髋部骨折在老年患者中很常见,且与死亡率过高相关。利用术前易于获取的信息快速准确地预测预后,将有利于临床管理。我们使用一个为期8.5年的日本索赔数据库(2012年4月至2020年9月)进行了一项基于人群的回顾性队列研究,以开发和验证髋部骨折后长期死亡率的预测模型。该研究纳入了43529例年龄≥65岁的首次发生髋部骨折的患者(34499例[79.3%]为女性)。在观察期内,43%的患者死亡。Cox回归分析确定了以下预后预测因素:性别、年龄、骨折部位、护理认证以及几种合并症(任何恶性肿瘤、肾病、充血性心力衰竭、慢性肺病、肝病、转移性实体瘤和缺铁性贫血)。然后,我们开发了一种名为静冈髋部骨折预后评分(SHiPS)的评分系统;该系统是通过根据每个风险比进行评分,并基于决策树分析将死亡风险程度分为四类而建立的。基于SHiPS的1年、3年和5年死亡率的受试者工作特征(ROC)曲线下面积(AUC)(95%置信区间[CI])分别为0.718(95%CI,0.706 - 0.729)、0.736(95%CI,0.728 - 0.745)和0.758(95%CI,0.747 - 0.769),表明SHiPS在骨折发生后长达5年的时间里具有良好的预测性能。即使将SHiPS单独应用于骨折后接受或未接受手术的患者,AUC的预测性能也>0.7。这些结果表明,无论髋部骨折后是否进行手术,SHiPS都可以使用术前信息预测长期死亡率。