Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
BMC Geriatr. 2023 Jul 12;23(1):432. doi: 10.1186/s12877-023-04065-z.
Hip fractures are common in elderly patients, and almost all the patients undergo surgery. This study aimed to develop a novel modified lymphocyte C-reactive protein (CRP) score (mLCS) to simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery.
A retrospective study was conducted on elderly patients who underwent intertrochanteric fracture surgery between January 2014 and December 2017. The mLCS was developed according to the value of CRP and lymphocyte counts. Univariate and multivariate Cox regression analyses were used to identify independent risk factors for 3-year mortality after surgery. The performances of the lymphocyte CRP score (LCS) and mLCS to predict 3-year mortality were then compared using C-statistics, decision curve analysis (DCA), net reclassification index (NRI) and integrated discrimination improvement (IDI).
A total of 291 patients were enrolled, of whom 52 (17.9%) died within 3 years after surgery. In the multivariate Cox regression analysis, mLCS (hazard ratio (HR), 5.415; 95% confidence interval (CI), 1.743-16.822; P = 0.003) was significantly associated with postoperative 3-year mortality. The C-statistics of LCS and mLCS for predicting 3-year mortality were 0.644 and 0.686, respectively. The NRI (mLCS vs. LCS, 0.018) and IDI (mLCS vs. LCS, 0.017) indicated that the mLCS performed better than the LCS. DCA also showed that mLCS had a higher clinical net benefit.
mLCS is a promising predictor that can simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery.
髋部骨折在老年患者中较为常见，几乎所有患者都需要接受手术治疗。本研究旨在开发一种新的改良淋巴细胞 C 反应蛋白（CRP）评分（mLCS），以便简单、方便地预测接受股骨转子间骨折手术的老年患者 3 年死亡率。
对 2014 年 1 月至 2017 年 12 月接受股骨转子间骨折手术的老年患者进行回顾性研究。mLCS 根据 CRP 和淋巴细胞计数的值进行制定。采用单因素和多因素 Cox 回归分析确定术后 3 年死亡率的独立危险因素。然后，使用 C 统计量、决策曲线分析（DCA）、净重新分类指数（NRI）和综合判别改善（IDI）比较 LCS 和 mLCS 预测 3 年死亡率的性能。
共纳入 291 例患者，其中 52 例（17.9%）在术后 3 年内死亡。多因素 Cox 回归分析显示，mLCS（风险比（HR），5.415；95%置信区间（CI），1.743-16.822；P=0.003）与术后 3 年死亡率显著相关。LCS 和 mLCS 预测 3 年死亡率的 C 统计量分别为 0.644 和 0.686。NRI（mLCS 与 LCS，0.018）和 IDI（mLCS 与 LCS，0.017）表明 mLCS 优于 LCS。DCA 还表明 mLCS 具有更高的临床净获益。
mLCS 是一种有前途的预测指标，可简单、方便地预测接受股骨转子间骨折手术的老年患者 3 年死亡率。
