股骨颈骨折患者入院临床特征对术后1年死亡率的影响

Impact of admission clinical characteristics on one-year postoperative mortality in patients with femoral neck fractures

关键词:  股骨颈骨折  入院临床特征  术后死亡  Cox回归

Key words:  femoral neck fracture  admission clinical characteristics  postoperative death  Cox regression

摘要:

目的研究入院临床特征(如年龄评分、性别、婚姻状况、入院类型等)对股骨颈骨折患者术后1年死亡率的影响。 方法使用结构化查询语言(SQL)从MIMIC-Ⅳ(2.2版本)数据库中查找股骨颈骨折患者的入院、手术及生化数据，并对数据进行整理。采用Kaplan-Meier生存分析方法评估不同入院临床特征对患者术后1年死亡率的影响，并依据性别和年龄评分进行亚组分析。使用多因素Cox比例风险回归模型拟合数据以获得风险比(HR)。 结果研究共纳入了1726例股骨颈骨折患者，其中394例在观察期内死亡，1332例在观察期内存活。Kaplan-Meier生存分析显示，年龄超过75岁的患者术后1年的死亡风险显著高于年龄不超过75岁的患者(P<0.001)；男性患者的术后死亡风险高于女性(P=0.006)；不同婚姻状况对术后死亡风险有显著影响(P<0.001)；急诊入院与观察入院患者的术后死亡风险差异无统计学意义(P=0.290)；使用政府保险的患者死亡风险更高(P<0.001)；患有高血压(P<0.001)和糖尿病(P=0.004)的患者预期死亡率较高。多因素Cox比例风险回归分析显示，年龄在75岁及以上的患者术后1年的死亡风险是年龄在75岁以下患者的2.63倍；男性患者的死亡风险是女性患者的1.75倍；丧偶患者的死亡风险是已婚患者的1.32倍。不同入院临床特征在亚组分析中的结果呈现出一定的差异性。 结论高龄、男性、丧偶、使用政府保险以及患有糖尿病或高血压的股骨颈骨折患者在术后1年面临更高的死亡风险，建议在临床工作中特别关注这些患者群体，采取更加积极的预防和干预措施以降低其死亡风险。

Abstract:

ObjectiveTo investigate the impact of admission clinical characteristics(e.g., age score, sex, marital status, admission type) on one-year postoperative mortality in patients with femoral neck fractures. MethodsStructured Query Language(SQL) was used to extract admission, surgical, and biochemical data of femoral neck fracture patients from the MIMIC-Ⅳ database(version 2.2), followed by data processing. Kaplan-Meier survival analysis was employed to assess the association between different admission clinical characteristics and one-year postoperative mortality, with subgroup analyses stratified by sex and age score. Multivariable Cox proportional hazards regression models were fitted to obtain hazard ratios(HR). ResultsA total of 1726 femoral neck fracture patients were included, of whom 394 died during the observation period and 1332 survived. Kaplan-Meier analysis revealed significantly higher mortality risk in patients aged >75 years vs ≤75 years(P<0.001), males versus females(P=0.006), and varied significantly by marital status(P<0.001). No statistically significant difference was observed between emergency and observational admissions(P=0.290). Patients with government insurance showed elevated mortality risk(P<0.001), as did those with hypertension(P<0.001) or diabetes(P=0.004). Cox regression demonstrated that patients ≥75 years had 2.63-fold higher mortality risk than younger patients; males had 1.75-fold higher risk than females; and widowed patients had 1.32-fold higher risk than married patients. Subgroup analyses revealed certain variations across different admission characteristics. ConclusionElderly, male, widowed, government-insured patients with diabetes or hypertension exhibit significantly higher one-year postoperative mortality. These high-risk populations warrant targeted clinical attention and aggressive preventive interventions to reduce mortality.