Development and temporal external validation of a novel nomogram for predicting one-year mortality in the elderly with hip fracture

Yangfan Gong¹Kai Zhang²Wei Chen³Haiyi Guo⁴Qiqi Yang¹Mingyue Shi¹Zhao Dong¹Zhuohao Yin¹Yuyu Zhang¹WEI GE^1*

• ¹Department of General Practice, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
• ²Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
• ³Department of Cardiology, First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
• ⁴College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, Massachusetts, United States

The univariate and multivariable logistic regression were utilized to identify independent risk factors linked to one-year mortality. A predictive nomogram was subsequently developed. The discriminatory power of the model and its accuracy were monitored by utilizing receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Furthermore, visual risk applications were developed to enhance usability. Results: The one-year mortality is 16.8%. A total of seven predictors, namely age, body mass index (BMI), fibrinogen (FIB), stroke, dementia, ASA (American Society of Anesthesiologists), intraoperative blood transfusion were identified by multivariate analysis from a total of 65 variables studied. The model constructed using these seven predictors displayed medium prediction ability, with an area under the ROC of 0.775 in the training set and 0.740 in the validation set. The calibration curve shows a good degree of fitting between the predicted and observed probabilities. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 8 and 64%, which was found to be between 6 and 80% in the external validation. Conclusion: Independent factors, including age, BMI, preoperative fibrinogen level, stroke, dementia, ASA, intraoperative blood transfusion are pivotal in influencing one-year survival rate for patients with hip fractures. This risk dynamic nomogram developed from these factors renders substantial predictive accuracy and clinical utility, providing a reliable basis for a reasonable and personalized treatment plan.