高龄患者髋关节置换术后预后不良的预测模型构建及验证

doi:10.3969/j.issn.1671-7171.2024.08.009

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Abstract 【Objective】To establish and validate a prediction model for poor prognosis after total hip replacement in older adult patients. 【Methods】A total of 85 elderly patients who underwent hip arthroplasty from February 2019 to July 2022 were selected. After 1 year follow-up, patients were divided into the poor prognosis group and the good prognosis group according to the prognosis of older adult patients after hip arthroplasty. By comparing the clinical data of the two groups, the influencing factors of the poor prognosis after total hip replacement in elderly patients were analyzed by binary Logistic regression method, the prediction model of the poor prognosis after total hip replacement in older adult patients was constructed by Logistic method, and the fitting degree was evaluated by Hosmer-Lemeshow test. Receiver operating characteristic curve (ROC) was plotted to evaluate the prediction model differentiation. 【Results】After 1 year of follow-up, 2 cases of the 85 patients were lost to follow-up, the follow-up rate was 97.65%. Among them, 22 patients had poor prognosis, the incidence of poor prognosis was 26.51%(22/83). The surgical severity score (P-POSSUM score) ≥15 points, rehabilitation intervention time of 7 days after surgery, bone density <-3 SD, controlled nutritional status (CONUT) score ≥5 points, monocyte-to-lymphocyte ratio (MLR) ≥1.13, and bone alkaline phosphatase (BLAP) and thyroid hormone (PTH) levels in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05).Binary Logistic regression analysis showed that P-POSSUM score, rehabilitation intervention time, bone mineral density, CONUT score and MLR were the influencing factors for poor prognosis after total hip replacement in older adult patients (P<0.05). Taking the above influencing factors as predictive variables, a nomogram prediction model was established. The total score of each factor ranged from 76 to 426, and the corresponding risk rate ranged from 0.05 to 0.80. The C-index of the nomogram model was 0.825, and the correction curve for predicting the risk of poor prognosis after total hip replacement in older adult patients was close to the ideal curve (P>0.05). ROC curve results showed that the sensitivity and specificity of the nomogram model in predicting total poor prognosis after hip replacement in older adult patients were 90.91% and 88.52%, respectively. The area under the curve (AUC) was 0.903. 【Conclusion】P-POSSUM score, rehabilitation intervention time, bone mineral density, CONUT score and MLR are associated with the risk of poor prognosis after total hip arthroplasty in older adult patients. The construction of a nomogram model is helpful for early screening of the risk of poor prognosis after total hip arthroplasty in older adult patients.

Key words： Arthroplasty, Replacement, Hip Aged Prognosis

Received: 11 May 2024

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R684.7

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	YI Xinming
	WAN Shunxin
	ZHANG Jie
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Cite this article:

YI Xinming,WAN Shunxin,ZHANG Jie, et al. Construction and Validation of Prediction Model for Poor Prognosis after Total Hip Replacement in Older Adult Patients[J]. JOURNAL OF CLINICAL RESEARCH, 2024, 41(8): 1148-1151.

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http://journal07.magtech.org.cn/yxlcyj/EN/10.3969/j.issn.1671-7171.2024.08.009 OR http://journal07.magtech.org.cn/yxlcyj/EN/Y2024/V41/I8/1148

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