年龄校正Charlson合并症指数在老年股骨颈骨折患者跌倒风险中的预测效果

Predictive effect of age-adjusted Charlson comorbidity index on the risk of falls in elderly patients with femoral neck fractures

目的分析年龄校正Charlson合并症指数(ACCI)在老年股骨颈骨折患者跌倒风险预测中的应用价值。方法本研究为回顾性队列研究。采用整群抽样法,选取2021年6月—2022年6月于西安交通大学附属红会医院诊断为股骨颈骨折的1050例患者为研究对象,根据患者合并症计算ACCI总评分,根据跌倒危险因素评估表分值是否≥4分将患者分为跌倒低危组(n=282)和跌倒高危组(n=768)。比较两组患者年龄、性别、美国麻醉医师协会(ASA)分级、ACCI评分、白细胞计数、红细胞计数、血小板计数、淋巴细胞计数、血清白蛋白、血红蛋白、肌酐及尿素氮水平的差异,将P<0.05的自变量纳入二元Logistic回归,分析影响患者跌倒风险的因素,并绘制受试者工作特征曲线(ROC)。结果两组患者的年龄、ASA分级、红细胞计数、淋巴细胞计数、ACCI评分、血清白蛋白、血红蛋白、血清肌酐值、尿素氮水平比较,差异有统计学意义(P<0.05);Logistic回归分析结果显示,年龄、ASA评分、ACCI评分是跌倒风险的独立危险因素(P<0.05),血清白蛋白是跌倒风险的独立保护因素(P<0.05)。ACCI预测跌倒风险的ROC曲线下面积为0.892,且ACCI评分4分为预测跌倒风险的分界值。结论ACCI可作为评估和预测老年股骨颈骨折患者跌倒风险的辅助工具,能够为临床筛查跌倒高风险人群提供借鉴。

Objective To analyze the predictive value of age-adjusted Charlson comorbidity index(ACCI)on the risk of falls in elderly patients with femoral neck fractures.Methods This study was a retrospective cohort study.From June 2021 to June 2022,cluster sampling was used to select 1050 patients with femoral neck fractures at the Honghui Hospital affiliated with Xi'an Jiaotong University as the study subject.This study calculated the total ACCI score based on patient comorbidities,and divided patients into a low-risk fall group(n=282)and a high-risk fall group(n=768)based on whether the fall risk factor assessment score was≥4.This study compared the differences in age,gender,American Society of Anesthesiologists(ASA)grading,ACCI score,white blood cell count,red blood cell count,platelet count,lymphocyte count,serum albumin,hemoglobin,creatinine,and urea nitrogen between the two groups.Independent variables with P<0.05 were included in binary Logistic regression to analyze the factors affecting the risk of falls in patients,and a receiver operating characteristic(ROC)curve was plotted.Results There were statistically significant differences in age,ASA grading,red blood cell count,lymphocyte count,ACCI score,serum albumin,hemoglobin,creatinine,and urea nitrogen between the two groups of patients(P<0.05).Logistic regression analysis found that age,ASA score,and ACCI score were independent risk factors for fall risk(P<0.05),while serum albumin was an independent protective factor for fall risk(P<0.05).The area under the ROC curve of ACCI for predicting fall risk was 0.892,and a score of 4 in ACCI was the cutoff value for predicting fall risk.Conclusions ACCI can serve as an auxiliary tool for evaluating and predicting the risk of falls in elderly patients with femoral neck fractures,and can provide reference for clinical screening of high-risk individuals for falls.