基于CRP/Hb、TLC、Na^(+)构建老年髋部骨折术后死亡风险的预测模型

Construction of a prediction model of postoperative mortality risk for elderly patients with hip fractures based on CRP/Hb TLC,and Na^(+)

目的基于C反应蛋白与血红蛋白比值(C-reactive protein/hemoglobin,CRP/Hb)、淋巴细胞总数(total lymphocyte count,TLC)、血钠(Na^(+))构建老年髋部骨折术后死亡风险的预测模型,为临床决策和干预提供参考。方法选取行老年髋部骨折手术患者415例,根据术后3个月内是否死亡分为死亡组(10例)、存活组(405例)。比较2组基线资料、CRP/Hb、TLC、Na^(+),应用多因素Logistic回归方程分析预后的相关影响因素,应用受试者工作特征曲线(receiver operating characteristic,ROC)及曲线下面积(area under the curve,AUC)构建各指标预测死亡风险的模型,采用卡普兰-迈耶曲线(Kaplan-Meier,KM)生存曲线分析各指标高危与低危患者生存率。结果死亡组美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、慢性肺部疾病、术中输血比例高于存活组,差异有统计学意义(P<0.05)。死亡组CRP/Hb呈升高趋势,TLC、Na^(+)呈降低趋势,存活组CRP/Hb、TLC、Na^(+)变化趋势不明显,死亡组CRP/Hb升于存活组,TLC、Na^(+)降于存活组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。多因素Logistic回归方程分析结果显示,术后1周、术后2周CRP/Hb、TLC、Na^(+)是预后的影响因素(P<0.05)。术后2周,CRP/Hb、TLC、Na^(+)及联合预测死亡的AUC依次为0.838、0.844、0.852、0.947;CRP/Hb、TLC、Na^(+)高危患者生存率低于低危患者(P<0.05)。结论CRP/Hb、TLC、Na^(+)均是老年髋部骨折术后死亡的影响因素,可作为预测患者预后的标志物,为临床决策、干预提供参考信息。

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.