Development of a new comprehensive preoperative risk score for predicting 1-year mortality in patients with hip fracture: the HULP-HF score. Comparison with 3 other risk prediction models
Restricted accessResearch articleFirst published online November, 2021
Development of a new comprehensive preoperative risk score for predicting 1-year mortality in patients with hip fracture: the HULP-HF score. Comparison with 3 other risk prediction models
The aim of this study was to develop a new comprehensive preoperative risk score for predicting mortality during the first year after hip fracture (HF) and its comparison with 3 other risk prediction models.
Methods:
All patients admitted consecutively with a fragility HF during 1 year in a co-managed orthogeriatric unit at a university hospital were assessed and followed for 1 year. Factors independently associated with 1-year mortality were used to create the HULP-HF (Hospital Universitario La Paz – Hip Fracture) score. The predictive validity, discrimination and calibration of the HULP-HF score, the American Society of Anesthesiologists (ASA) scale, the abbreviated Charlson comorbidity index (a-CCI) and the Nottingham Hip Fracture score (NHFS) were compared. Discriminative performance was assessed using the area under the curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit-test.
Results:
509 patients were included. 1-year mortality was 23.2%. The 8 independent mortality risk factors included in the HULP-HF score were age >85 years, baseline functional and cognitive impairment, low body mass index, heart disease, low hand-grip strength, anaemia on admission, and secondary hyperparathyroidism associated with vitamin D deficiency. The AUC was 0.79 in the HULP-HF score, 0.66 in the NHFS, 0.61 in the abbreviated CCI and 0.59 in the ASA scale. The HULP-HF score, the NHFS and the abbreviated CCI all presented good levels of calibration (p > 0.05).
Conclusions:
The HULP-HF score has a predictive capacity for 1-year mortality in HF patients slightly superior to that of other previously existing scores.
SingerAExuzidesASpanglerL, et al. Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc2015; 90: 53–62.
2.
HernlundESvedbomAIvergårdM, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos2013; 8: 136.
3.
SmithTPelpolaKBallM, et al. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing2014; 43: 464–471.
4.
HuFJiangCShenJ, et al. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury2012; 43: 676–685.
5.
ShigaTWajimaZOheY.Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anesth2008; 55: 146–154.
6.
SchnellSFriedmanSMMendelsonDA, et al. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil2010; 1: 6–14.
7.
PioliGFrondiniCLauretaniF, et al. Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units. Arch Gerontol Geriatr2012; 55: 316–322.
8.
HommelAUlanderKBjorkelundKB, et al. Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury2008; 39: 1164–1174.
9.
PioliGBaroneAGiustiA, et al. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res2006; 18: 381–387.
10.
HendersonCYShanahanEButlerA, et al. Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci2017; 186: 179–184.
11.
FolbertECHegemanJHVermeerM, et al. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteoporos Int2017; 28: 269–277.
12.
KiefferWKMRennieCSGandheAJ.Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur. Ann R Coll Surg Engl2013; 95: 26–28.
13.
HaentjensPMagazinerJColón-EmericCS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med2010; 152: 380–390.
14.
LaulundASLauritzenJBDuusBR, et al. Routine blood tests as predictors of mortality in hip fracture patients. Injury2012; 43: 1014–1020.
15.
MojaLPiattiAPecoraroV, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One2012; 7: e46175.
16.
SimunovicNDevereauxPJSpragueS, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ2010; 182: 1609–1616.
17.
ElliottJBeringerTKeeF, et al. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol2003; 56: 788–795.
18.
JiangHXMajumdarSRDickDA, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res. Epub ahead of print 29 November 2004. DOI: 10.1359/JBMR.041133.
19.
CenzerISTangVBoscardinWJ, et al. One-year mortality after hip fracture: development and validation of a prognostic index. J Am Geriatr Soc2016; 64: 1863–1868.
20.
WilesMDMoranCGSahotaO, et al. Nottingham hip fracture score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth2011; 106: 501–504.
21.
RenHWuLHuW, et al. Prognostic value of the c-reactive protein/prognostic nutritional index ratio after hip fracture surgery in the elderly population. Oncotarget2017; 8: 61365–61372.
22.
BliemelCSielskiRDoeringB, et al. Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture—development of a new scoring system. Osteoporos Int2016; 27: 1979–1987.
23.
Menéndez-ColinoRAlarconTGotorP, et al. Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA cohort). Injury2018; 49: 656–661.
24.
González-MontalvoJIAlarcónTMauleónJL, et al. The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture. Hip Int2010; 20: 229–235.
25.
HoldenMKGillKMMagliozziMR, et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther1984; 64: 35–40.
26.
Cabañero-MartínezMJCabrero-GarcíaJRichart-MartínezM, et al. The Spanish versions of the Barthel index (BI) and the Katz index (KI) of activities of daily living (ADL): a structured review. Arch Gerontol Geriatr2009; 49: e77–e84.
27.
González-MontalvoJISalgadoA.Validación del cuestionario de Pfeiffer y la escala de incapacidad mental de la Cruz Roja en la detección del deterioro mental en los pacientes externos de un servicio de geriatría. Rev Esp Geriatr Gerontol1992; 27: 129–133.
28.
González-MontalvoJIAlarcónTGotorP, et al. Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int2016; 16: 1021–1027.
29.
WoltersUWolfTStützerH, et al. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth1996; 77: 217–222.
30.
MaxwellMJMoranCGMoppettIK.Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth2008; 101: 511–517.
31.
BerkmanLFLeo-SummersLHorwitzRI.Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Ann Intern Med1992; 117: 1003–1009.
32.
CharlsonMEPompeiPAlesKL, et al. A new method of classifying prognostic in longitudinal studies: development and validation. J Chronic Dis1987; 40: 373–383.
33.
LauTWFangCLeungF.Assessment of postoperative short-term and long-term mortality risk in Chinese geriatric patients for hip fracture using the Charlson comorbidity score. Hong Kong Med J2015; 22: 16–22.
34.
HanleyJAMcNeilBJ.The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology1982; 143: 29–36.
35.
LemeshowSHosmerDWJr.A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol1982; 115: 92–106.
36.
HosmerDWLemesbowS.Goodness of fit tests for the multiple logistic regression model. Commun Stat Theory Methods1980; 9: 1043–1069.
37.
KarresJHeesakkersNAUlteeJM, et al. Predicting 30-day mortality following hip fracture surgery: evaluation of six risk prediction models. Injury2015; 46: 371–377.
