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The Metastatic Early Prognostic (MEP) score.
Samantha Downie1, Florence Y Lai2, Judith Joss1
1NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.
The Bone & Joint Journal
|January 1, 2020
Summary
Patients with hip fractures from bony metastases have high early mortality. A new Metastatic Early Prognostic (MEP) score, using albumin, urea, and calcium, predicts 90-day survival.
Area of Science:
- Orthopaedic Surgery
- Oncology
- Geriatric Medicine
Background:
- Early mortality in patients with hip fractures due to bony metastases is not well-defined.
- Proximal femoral metastases (PFM) represent a significant cause of morbidity and mortality in cancer patients.
Purpose of the Study:
- To quantify 30- and 90-day mortality in patients with PFM.
- To develop a predictive tool for early mortality using biomarkers.
Main Methods:
- Retrospective cohort study of patients with PFM versus a matched control group.
- Data collected over a seven-year period (2010-2016) at a UK trauma centre.
- Minimum one-year follow-up period.
Main Results:
- 90-day mortality was 46% in the PFM group versus 12% in controls (p < 0.001).
- Albumin, urea, and corrected calcium levels independently predicted early mortality.
- The Metastatic Early Prognostic (MEP) score effectively stratified patients by 30- and 90-day mortality risk.
Conclusions:
- The MEP score can predict early mortality in PFM patients, aiding perioperative counselling.
- Delayed surgery in PFM patients presents an opportunity for intervention to improve survival.
- Biomarkers like albumin, urea, and calcium are crucial for prognostic assessment.
