年龄校正Charlson合并症指数对髋部骨折病人内科并发症的预测效果分析

Predictive Effect of ACCI on Medical Complications in Patients with Hip Fracture

目的探讨年龄校正Charlson合并症指数(age⁃adjusted Charlson comorbidity index,ACCI)对髋部骨折病人内科并发症的预测效果。方法回顾性分析2015年1月至2020年12月于天津医院住院治疗的1062例髋部骨折病人的资料,其中男317例,女745例,年龄为(69.81±13.43)岁。对病人住院病历资料进行回顾性ACCI评分,计算出每个病人的ACCI总评分,将其归类为低危0~2分,中危3~5分,高危6~8分,极高危≥9分。根据病人髋部骨折后是否出现并发症分为内科并发症组(593例)和非内科并发症组(469例)。比较两组病人年龄、骨折类型、住院时间、ACCI评分、冠心病、糖尿病、脑血管疾病、心力衰竭、贫血、低蛋白血症、脑萎缩、动脉硬化性疾病的差异,对上述差异有统计学意义的变量进一步行多因素Logistic回归分析。结果两组年龄、骨折类型、住院时间、ACCI评分、冠心病、糖尿病、脑血管疾病、心力衰竭、贫血、低蛋白血症、动脉硬化性疾病的差异有统计学意义(P<0.05),多因素Logistic回归分析显示住院时间[OR=1.011,95%CI(1.006,1.017),P<0.001]、ACCI评分[OR=6.333,95%CI(4.949,8.103),P<0.001]、冠心病[OR=0.579,95%CI(0.409,0.872),P=0.008]和贫血[OR=1.536,95%CI(1.097,2.150),P=0.012]是髋部骨折病人发生内科并发症的独立危险因素。结论单独使用ACCI预测髋部骨折病人的内科并发症具有一定的价值。

Objective To explore the predictive effect of age⁃corrected Charlson complication index(ACCI)on medical complications in patients with hip fracture.Methods The data of 1062 patients with hip fracture treated in Tianjin Hospital from January 2015 to December 2020 were analyzed retrospectively.The retrospective ACCI score was used to calculate the total ACCI score of each patient.The total ACCI score was classified as low risk(0⁃2),medium risk(3⁃5),high risk(6⁃8),very high risk(≥9).According to the occurrence of complications after hip fracture,the patients were divided into medical complication group(593 cases)and non⁃medical complication group(469 cases).The differences in age,fracture type,length of hospital stay,ACCI score,coronary heart disease,diabetes,cerebrovascular disease,heart failure,anemia,hypoproteinemia,cerebral atrophy and arteriosclerotic disease between the two groups were compared.The variables with statistical significance were further analyzed by multivariate Logistics regression analysis.Results There were significant differences in age,type of fracture,length of hopital stay,ACCI score,coronary heart disease,diabetes,cerebrovascular disease,heart failure,anemia,hypoproteinemia and arteriosclerotic disease between the two groups.Multivariate Logistics regression analysis showed that the length of hospital stay[OR=1.011,95%CI(1.006,1.007),P<0.001],ACCI[OR=6.333,95%CI(4.949,8.103),P<0.001],coronary heart disease[OR=0.579,95%CI(0.409,0.872),P=0.008]and anemia[OR=1.536,95%CI(1.097,2.150),P=0.012]were independent risk factors for medical complications in patients with hip fracture.Conclusion ACCI alone is of certain value in predicting medical complications in patients with hip fracture.