Liu Yazhou, Yang Ying, Li Yuhao, Yang Xiaodong
Graduate School, Dalian Medical University, Dalian, China.
Graduate School, China Medical University, Shenyang, China.
Front Nutr. 2025 Sep 10;12:1639306. doi: 10.3389/fnut.2025.1639306. eCollection 2025.
Despite the availability of several interventions, the incidence of pressure ulcers (PU) has not significantly decreased, particularly in older adults undergoing hip fracture surgery. Therefore, there is an urgent need to develop and validate a more reliable and effective predictor to enhance the prediction accuracy for PU development in this vulnerable population.
In this study, a reliable and convenient predictor of PU was developed and evaluated based on four commonly used hematological markers. The data were randomly divided into a training cohort and a validation cohort in a 7:3 ratio. The strength of the association between each predictor and the occurrence of PU was assessed using multivariate logistic regression analysis and propensity score matching (PSM). For predictors with significant associations, the receiver operating characteristic (ROC) curve and its parameters were further applied to select the best predictive model. The model was subsequently validated by a systematic evaluation of its discriminative ability, correlation, and predictive performance. Additionally, threshold analysis, subgroup analysis, and further exploration of the relationship between the GAR indicator and length of hospitalization (LOS) was conducted.
A total of 1,279 older adults undergoing hip fracture surgery were included in this study, with 156 (12.2%) developing PU postoperatively. Multivariate logistic regression and PSM analyses revealed a nonlinear positive correlation between GAR and postoperative PU (OR = 1.84, 95% CI: 1.44-2.35). The area under the ROC curve (AUC) for GAR was 0.72, indicating moderate predictive ability. Furthermore, each 0.1-unit increase in preoperative GAR was associated with an approximately 0.17-day increase in the length of hospitalization.
Preoperative GAR levels are a moderate predictor of the risk of postoperative PU and LOS in older adults with hip fractures.
尽管有多种干预措施，但压疮（PU）的发生率并未显著下降，尤其是在接受髋部骨折手术的老年人中。因此，迫切需要开发并验证一种更可靠、有效的预测指标，以提高对这一脆弱人群发生压疮的预测准确性。
在本研究中，基于四种常用血液学指标开发并评估了一种可靠且便捷的压疮预测指标。数据按7:3的比例随机分为训练队列和验证队列。使用多因素逻辑回归分析和倾向得分匹配（PSM）评估每个预测指标与压疮发生之间的关联强度。对于具有显著关联的预测指标，进一步应用受试者工作特征（ROC）曲线及其参数来选择最佳预测模型。随后通过对其判别能力、相关性和预测性能进行系统评估来验证该模型。此外，还进行了阈值分析、亚组分析，并进一步探讨了GAR指标与住院时间（LOS）之间的关系。
本研究共纳入1279例接受髋部骨折手术的老年人，其中156例（12.2%）术后发生压疮。多因素逻辑回归和PSM分析显示，GAR与术后压疮呈非线性正相关（OR = 1.84，95%CI：1.44 - 2.35）。GAR的ROC曲线下面积（AUC）为0.72，表明具有中等预测能力。此外，术前GAR每增加0.1个单位，住院时间大约增加0.17天。
术前GAR水平是老年髋部骨折患者术后发生压疮风险和住院时间的中等预测指标。
