Abstract:

Objective  To construct a prediction model of postoperative mortality risk in elderly patients with hip fractures based on the C-reactive protein/hemoglobin(CRP/Hb), the total lymphocyte count(TLC), and blood sodium(Na+), so as to provide reference for clinical decision-making and intervention.

Methods  A total of 415 elderly patients undergoing hip fracture surgery were selected and divided into mortality group(n=10) and survival group(n=405) according to presence or absence of mortality within 3 months after surgery. The baseline data, CRP/Hb, TLC, and Na+ were compared between two groups, and the multivariate Logistic regression equation was used to analyze the influencing factors of the prognosis. Receiver operating characteristic(ROC) and the area under the ROC curve(AUC) were used to construct a model for predicting the mortality risk by various indicators, and the Kaplan-Meier(KM) survival curve was used to analyze the survival rate of high-risk and low-risk patients with each indicator.

Results  The proportion of the American Society of Anesthesiologists(ASA) classification, chronic lung disease, intraoperative blood transfusion in the mortality group was higher than that in the survival group, and the difference was statistically significant(P＜0.05). CRP/Hb showed an upward trend, while TLC and Na+ showed a downward trend in the mortality group; the change trend of CRP/Hb, TLC and Na+ was not significant in the survival group. CRP/Hb in the mortality group was higher than that in the survival group, while TLC and Na+ were lower than that in the survival group. There was significant difference in the interaction between groups, time points and time points between groups(P＜0.05). Multivariate Logistic regression equation analysis showed that CRP/Hb, TLC, and Na+ at 1 and 2 weeks after operation were influencing factors of the prognosis(P＜0.05). At 2 weeks after operation, the AUC of CRP/Hb, TLC, Na+ and their combined detection in predicting the mortality was 0.838, 0.844, 0.852, and 0.947, respectively; The survival rate of CRP/Hb, TLC, Na+ high-risk patients was lower than that of low-risk patients(P＜0.05).

Conclusion  CRP/Hb, TLC, and Na+ are influencing factors of mortality of elderly patients after hip fracture surgery. They can be used as markers to predict the prognosis of patients and provide reference information for clinical decision-making and intervention.

Key words: hip fractures, death, forecasting