入院检查指标与骨质疏松椎体压缩性骨折患者术后死亡率的相关性分析

Correlation analysis between admission examination indexes and postoperative mortality in patients with osteoporotic vertebral compression fractures

目的:探讨入院实验室检查各指标与骨质疏松椎体压缩性骨折(OVCF)患者行经皮球囊扩张椎体后凸成形术(PKP)治疗后死亡率的相关性。方法:选取2018年6月至2022年6月在包头市第三医院经同一手术小组诊断为OVCF并行PKP手术治疗的患者,收集患者入院时血常规、血生化指标及基本信息,随访患者术后生存情况及Oswestry功能障碍指数问卷(ODI)。根据随访期间患者是否存活将患者分为生存组及死亡组两组。对两组患者入院时相关检查指标进行比较,分析患者死亡结局的影响因素。结果:176例OVCF的患者术后一年死亡率为6.81%(12/176),随访观察期间患者总死亡率为18.75%(33/176)。骨密度(BMD)预测患者死亡的AUC为0.797(95%CI:0.699-0.895,P<0.05),当敏感性为66.7%、特异性为85.3%时诊断指数最大为0.520,诊断截点为-3.430。白蛋白(ALB)预测患者死亡的AUC为0.676(95%CI:0.572-0.780,P<0.05),当敏感性为63.6%、特异性为70.6%时诊断指数最大为0.342,诊断截点为39.450 g/L。中性粒细胞与淋巴细胞比率(NLR)预测患者死亡的AUC为0.786(95%CI:0.693-0.879,P<0.05),当敏感性为81.8%、特异性为65.0%时诊断指数最大为0.468,诊断截点为3.120。BMD、ALB、NLR三个指标联合后预测患者死亡的AUC为0.871(95%CI:0.798-0.945,P<0.05),当敏感性为75.8%、特异性为86.7%时诊断指数最大为0.625,诊断截点为4.945,高于NLR、BMD及ALB单个指标的曲线下面积。结论:BMD、ALB、NLR三个指标联合后(联合指标Y=0.528×NLR-3.526×BMD-0.227×ALB)可以更好预测患者死亡率。

Objective:To investigate the correlation between the indexes of laboratory examination and the mortality of patients with osteoporotic vertebral compression fracture(OVCF)after percutaneous kyphoplasty(PKP).Methods:Patients who were diagnosed as OVCF and treated with PKP by the same surgical team in the Third Hospital of Baotou from June 2018 to June 2022 were selected.The blood routine,blood biochemical indexes and basic information of the patients at admission were collected,and the postoperative survival and Oswestry dysfunction index(ODI)questionnaire were followed up.According to whether the patients survived during the follow-up period,the patients were divided into survival group and death group.The related examination indexes of the two groups of patients at admission were compared,and the influencing factors of the death outcome of the patients were analyzed.Results:The 1-year mortality rate of 176 patients with OVCF was 6.81%(12/176),and the total mortality rate was 18.75%(33/176)during the follow-up period.The AUC of bone mineral density(BMD)in predicting death was 0.797(95%CI:0.699-0.895,P<0.05),when the sensitivity was 66.7%and the specificity was 85.3%,the maximum diagnostic index was 0.520,and the diagnostic cut-off point was-3.430.The AUC of albumin(ALB)in predicting death was 0.676(95%CI:0.572-0.780,P<0.05),when the sensitivity was 63.6%and the specificity was 70.6%,the diagnostic index was 0.342,and the diagnostic cut-off point was 39.450 g/L.The AUC of neutrophil-to-lymphocyte ratio(NLR)in predicting death was 0.786(95%CI:0.693-0.879,P<0.05),when the sensitivity was 81.8%and the specificity was 65.0%,the diagnostic index was 0.468,and the diagnostic cut-off point was 3.120.The AUC of BMD,ALB and NLR combined to predict the death of patients was 0.871(95%CI:0.798-0.945,P<0.05).When the sensitivity was 75.8%and the specificity was 86.7%,the maximum diagnostic index was 0.625,and the diagnostic cut-off point was 4.945,which was higher than the area under the curve of NLR,BMD and ALB.Conclusion:The combination of BMD,ALB and NLR(combined index Y=0.528×NLR-3.526×BMD-0.227×ALB)can better predict the mortality of patients.