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Efficiently stratifying mid-term death risk in femoral fractures in the elderly: introducing the ASAgeCoGeCC Score

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Abstract

Summary

We evaluated mortality in a cohort of hip fracture patients and implemented a risk prediction score named ASAgeCoGeCC with excellent discrimination. It allowed to separate patients in 3 different risk groups with distinct mortality rates. Recognition of the heterogeneity of patients with femoral fractures may have relevant implications for their management.

Introduction

Usage of risk prediction models to estimate postoperative mortality risk for hip fracture patients represents a useful tool to give insight in the prognosis and assist in clinical decision-making. The aim of this study was to identify a predictive model able to determine the possible presence of distinct subgroups of hip fracture patients by risk classes in the mid-term.

Methods

Three hundred twenty-three hip fracture patients were evaluated, and mortality rates at 30 days, 1, 2, and 4 years were calculated. A multivariate logistic regression analysis using mortality 4 years after fracture as a dependent variable found ASA score, age, cognitive status, gender, and Charlson Comorbidities Index (CCI) as significant risk factors. Using these items, a score named ASAgeCoGeCC was implemented and compared with CCI and Nottingham Hip Fracture Score (NHFS) by a receiver operating characteristic (ROC) curve.

Results

The area under the ROC curve for ASAgeCoGeCC was always greater than that of CCI and NHFS and ranged between 0.804 and 0.820 suggesting an excellent discrimination. The ASAgeCoGeCC logistic model showed also a good calibration. Patients were divided in 3 groups: a low risk group, an intermediate risk group with an odds ratio for 4-year mortality of 5.6 (95% CI 2.9–10.6), and a high risk group with an odds ratio 21.6 (95% CI 10.6–44).

Conclusion

The ASAgeCoGeCC Score is a predictive tool for mortality after hip fracture with good calibration and excellent discrimination properties. It is the first scoring system stratifying hip fracture patients’ mortality at 4 years from fracture.

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The data that support the findings of this study are available from the corresponding author upon reasonable request.

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  1. UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Via Paderno 21, 24065, Seriate, BG, Italia

    C. Trevisan, G. Gallinari, A. Carbone & R. Klumpp

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  1. C. Trevisan
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  2. G. Gallinari
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Trevisan, C., Gallinari, G., Carbone, A. et al. Efficiently stratifying mid-term death risk in femoral fractures in the elderly: introducing the ASAgeCoGeCC Score. Osteoporos Int 32, 2023–2031 (2021). https://doi.org/10.1007/s00198-021-05932-4

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