Establishment and validation of a prediction model for hip fracture in the aged patients with knee osteoarthritis
10.3760/cma.j.cn115530-20240611-00248
- VernacularTitle:老年膝关节骨关节炎患者发生髋部骨折的风险预测模型构建与验证研究
- Author:
Zhengtong LIN
1
;
Hao WANG
1
;
Ruilong QI
1
;
Guohong XU
1
;
Lihong WANG
1
Author Information
1. 温州医科大学附属东阳医院关节外科，东阳 322100
- Publication Type:Journal Article
- Keywords:
Hip fractures;
Osteoarthritis;
Risk factors;
Nomogram;
Prediction model
- From:
Chinese Journal of Orthopaedic Trauma
2024;26(12):1055-1061
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To develop and verify a predictive model for hip fracture risk in the aged patients with knee osteoarthritis (KOA) on the basis of analysis of the risk factors associated with the hip fracture.Methods:A retrospective study was conducted to analyze the 701 patients who had been diagnosed with KOA (Kellgren-Lawrence grades 1 to 4) at Dongyang Hospital affiliated to Wenzhou Medical University from September 2013 to September 2023. The cohort consisted of 275 males and 426 females with an age of (76.5±8.4) years. The patients were divided into a fracture group ( n=145) and a fracture-free group ( n=556) based on whether a hip fracture occurred during the follow-up period. The 2 groups were compared in terms of age, gender, comorbidities, albumin level, absolute lymphocyte count, and Kellgren-Lawrence grade, etc. The items with P<0.05 were analyzed by a multivariate logistic regression model to identify the risk factors for hip fracture in the aged KOA patients. A clinical prediction model based on the above risk factors was constructed and validated for hip fracture risk in the aged KOA patients. Results:Multivariate logistic regression analysis identified the following as independent risk factors for hip fracture in the aged KOA patients: female ( OR=2.009, 95% CI: 1.280 to 3.154, P=0.002), age ≥75 years ( OR=2.313, 95% CI: 1.493 to 3.583, P=0.001), Kellgren-Lawrence grades of 3-4 ( OR=2.348, 95% CI: 1.533 to 3.596, P=0.001), an albumin level <35 g/L ( OR=0.316, 95% CI: 0.191 to 0.522, P=0.001), and an absolute lymphocyte count <0.8×10 9/L ( OR=0.133, 95% CI: 0.069 to 0.253, P=0.001). The area under the ROC curve (AUC) for the model developed by this study was 0.753 in the training set and 0.815 in the validation set ( P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the consistency between the predicted risk and the actual risk was good in the training and validation sets ( P<0.05). The calibration curves for both the training and validation sets closely aligned with the ideal curve. The clinical decision curve analysis showed that the nomogram model had a good net benefit rate and a good predictive potential. Conclusions:Female, age ≥75 years, Kellgren-Lawrence grades of 3-4, an albumin level <35 g/L, and an absolute lymphocyte count <0.8×10 9/L are independent risk factors for hip fracture in the aged KOA patients. Since the nomogram prediction model based on these risk factors is satisfactory in discrimination and calibration, it shows a certain predictive ability and application value in clinic.
