Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi.
Department of Nursing, Third Hospital of Hebei Medical University.
Int J Surg. 2024 Aug 1;110(8):4754-4766. doi: 10.1097/JS9.0000000000001472.
The association between allogenic blood transfusions and all-cause mortality in surgically treated hip fracture patients with perioperative transfusion (STHFPT) remained unknown. The authors aim to introduce transfusion-related factors, new variables to develop, and validate models to predict mortality in these patients.
A prospective multicenter cohort study was conducted with STHFPT hospitalized during January 2018 and June 2021. The database was divided into training cohort and validation cohort in a ratio of 70-30% using the randomization method. All participants received a minimum of 2-year follow-up and all participants' overall and eight time-specific survival status were recorded. Prediction models were developed using multivariate logistic regression and Cox regression for variable selection. Model performance was measured by determining discrimination, calibration, overall model performance or precision, and utility. Sensitivity analyses were performed to test robustness of the results.
A total of 7074 consecutive patients were prospectively screened and assessed for eligibility to participate. Finally, 2490 patients met our inclusion and exclusion criteria and 1743 (70%) patients were randomized to the training cohort and 747 (30%) to the validation cohort. The median duration of follow-up was 38.4 months (IQR 28.0-62.0). Our novel models highlight that preoperative transfusion is of significance for short-term mortality while mid-term outcomes are predominantly determined by severe complications, pulmonary complications, and advanced age. Our models showed high discriminative power, good calibration, and precision for mortality prediction in both training and validation cohorts, especially in short-term mortality prediction.
The authors introduce transfusion-related factors, new variables to develop, and validate models to predict mortality with STHFPT. The models can be further tested and updated with the ultimate goal of assisting in optimizing individual transfusion strategy.
异体输血与围手术期输血的手术治疗髋部骨折患者（STHFPT）的全因死亡率之间的关系尚不清楚。作者旨在介绍与输血相关的因素、新的变量开发以及验证模型，以预测这些患者的死亡率。
这是一项前瞻性多中心队列研究，纳入了 2018 年 1 月至 2021 年 6 月期间住院的 STHFPT 患者。使用随机分组的方法，将数据库分为训练队列和验证队列，比例为 70-30%。所有参与者均接受了至少 2 年的随访，记录了所有参与者的总体和 8 个时间特定的生存状态。使用多变量逻辑回归和 Cox 回归进行变量选择来建立预测模型。通过确定判别力、校准、整体模型性能或精度和实用性来衡量模型性能。进行敏感性分析以测试结果的稳健性。
共对 7074 例连续患者进行了前瞻性筛选和评估，以确定是否符合纳入标准。最终，2490 例患者符合纳入和排除标准，其中 1743 例（70%）患者被随机分配到训练队列，747 例（30%）患者被分配到验证队列。中位随访时间为 38.4 个月（IQR 28.0-62.0）。我们的新模型强调术前输血对短期死亡率有重要意义，而中期结果主要由严重并发症、肺部并发症和高龄决定。我们的模型在训练和验证队列中对死亡率预测均具有较高的判别能力、良好的校准和精度，尤其是在短期死亡率预测方面。
作者引入了与输血相关的因素、新的变量开发，并验证了预测 STHFPT 死亡率的模型。这些模型可以进一步进行测试和更新，最终目标是协助优化个体输血策略。
