Development and validation of a prognostic scoring system for 1-year mortality in older patients with hip fractures.

BACKGROUND

Hip fractures in older people result in increased mortality.

OBJECTIVE

We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively.

DESIGN

Retrospective study.

SETTING

Multicenter.

PARTICIPANTS

Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled.

METHODS

The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively.

RESULTS

We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively.

CONCLUSIONS

We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients.