目的 构建高龄髋部骨折患者术后新发衰弱的预测模型,为预防高龄患者术后新发衰弱提供依据。方法 选择2020-08至2021-10解放军总医院第七医学中心因髋部骨折行手术治疗的高龄患者,使用衰弱筛查量表(FRAIL量表)评估术后3个月内患者是否发生衰弱,分为衰弱组和非衰弱组。收集患者基本信息、术前诺丁汉髋部骨折评分(NHFS)、手术方式、麻醉方式、实验室检查等资料,通过肯德尔相关分析探求术前NHFS与术后发生衰弱的相关性,通过logistic多因素回归分析患者术后发生衰弱的影响因素并构建预测模型,通过受试者工作特征曲线(ROC曲线)评估模型预测效能。结果 共192例患者入组,其中衰弱组49例,非衰弱组143例,衰弱组患者的NHFS显著高于非衰弱组(P<0.001),且 NHFS评分的高低与衰弱的发生呈显著正相关(P＜0.001)。多因素logistic回归分析显示NHFS(OR=2.425,95%CI 1.438~4.090,P=0.001)、入院时营养预后指数(PNI)(OR=0.861,95%CI 0.767~0.966,P=0.011)、骨折类型(OR=5.692,95%CI 1.511~21.438,P=0.010)、住院期间血肌酐最高值(OR=1.151,95%CI 1.047~1.265,P=0.004)为术后新发衰弱的独立危险因素,上述4个独立危险因素联合预测的ROC曲线下面积(AUC)为0.797(P＜0.001),该模型预测效能较为理想,模型拟合度优(P=0.915)。结论 采用NHFS、PNI、骨折类型、住院期间血肌酐最高值所构建的预测模型,对高龄髋部骨折患者术后新发衰弱有较好的预测效能,可为早期干预术后新发衰弱提供依据。
Abstract
Objective To construct a prediction model for new-onset frailty in aged patients with hip fracture and provide a basis to protect aged patients from postoperative new-onset frailty.Methods The elderly patients with hip fracture who were admitted to the Seventh Medical Center of Chinese PLA General Hospital from August 1, 2020 to October 1, 2021 and underwent surgical treatment were included. FRAIL Screening Scale (FRAIL Scale) was used to evaluate those who suffer from frailty within three months after surgery, so that patients could be divided into frailty group and non-frailty group. Patients' basic information, preoperative nottingham hip fracture score (NHFS), surgical options, anesthetic methods, laboratory examination and other data were collected, Kendall correlation analysis was used to explore the correlation between preoperative NHFS and postoperative frailty, Logistic regression was used to analyze the interfering factors of postoperative frailty and construct the prediction model, and receiver operating characteristic curve (ROC curve) was used to evaluate the predictive efficiency of the model.Results A total of 192 patients were enrolled, including 49 patients in the frailty group and 143 patients in the non-frailty group. The NHFS of frailty group was significantly higher than that of non-frailty group (P<0.001) and NHFS was positively correlated with frailty (P<0.001). Logistic regression model analysis showd NHFS (OR=2.425, 95%CI 1.438-4.090, P=0.001), prognostic nutritional index (PNI) at admission [serum albumin (g/L) +5×lymphocyte count (109/L)] (OR=0.861, 95%CI 0.767-0.966, P=0.011), fracture type (OR=5.692, 95%CI 1.511-21.438, P=0.010), and the highest creatinine during hospitalization (OR=1.151, 95%CI 1.047-1.265, P=0.004) were independent risk factors for postoperative new-onset frailty. The area under curve (AUC) predicted by the above four independent risk factors was 0.797 (P<0.001).The predictive efficiency of the model was ideal and its fitting degree was excellent (P=0.915).Conclusions The prediction model based on NHFS, PNI, fracture type and the highest Cr value during hospitalization has a good predictive efficiency for postoperative new-onset frailty in aged patients with hip fracture, which can provide a basis for early intervention of postoperative new-onset frailty.
关键词
髋部骨折 /
高龄 /
术后 /
衰弱 /
诺丁汉髋部骨折评分
Key words
hip fracture /
the aged /
postoperative /
frailty /
nottingham hip fracture score
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基金
陆军装备课题(19QNP059);北京科委培育项目(Z 161100000 116074)
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