Related Experiment Video
Updated: Oct 5, 2025
Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Prognostic nomogram for risk of mortality after hip fracture surgery in geriatrics
Liping Pan1, Taiguo Ning1, Hao Wu1
1Department of Orthopedics, Peking University First Hospital, No 8 Xishiku Street, XiCheng, Beijing 100034, PR China.
Insights
This study developed a new nomogram to predict mortality risk in elderly patients after hip fracture surgery. The model combines age, Charlson Comorbidity Index (CCI), albumin, sodium, and hemoglobin for improved accuracy.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Hip fractures are a major health concern in the elderly, leading to significant morbidity and mortality.
- Accurate risk stratification is crucial for improving patient outcomes and surgical decision-making in geriatric hip fracture cases.
Purpose of the Study:
- To develop and validate a nomogram for predicting mortality risk in geriatric patients undergoing hip fracture surgery.
- To integrate the Charlson Comorbidity Index (CCI) with specific laboratory parameters for enhanced risk assessment.
Main Methods:
- Retrospective review of 454 geriatric patients (≥70 years) who underwent hip fracture surgery.
- Multivariate Cox proportional hazards regression to identify mortality risk factors.
- Nomogram development and validation using C-index, AUC, calibration curves, and decision curve analysis (DCA).
Main Results:
- Key predictors of mortality included age, CCI, serum albumin, sodium, and hemoglobin.
- The developed nomogram demonstrated good predictive accuracy with a C-index of 0.76 ± 0.02.
- AUC values for 6-month, 1-year, and 3-year mortality were 0.83, 0.79, and 0.77, respectively, indicating strong performance.
Conclusions:
- A novel nomogram integrating age, CCI, albumin, sodium, and hemoglobin effectively stratifies mortality risk in geriatric hip fracture patients.
- Internal validation confirmed the nomogram's accuracy and clinical utility.
- The proposed nomogram offers improved convenience and precision over existing models, with external validation recommended.
Purpose:
Hip fracture is a significant public health problem, with associated high morbidity and mortality. Orthopedic surgeons are concerned to improve prognosis and stratify mortality risk after hip fracture surgery. This study established a nomogram that combines the Charlson Comorbidity Index (CCI) with specific laboratory parameters to predict mortality risk after hip fracture surgery in geriatrics.
Methods:
The records of consecutive patients who underwent hip fracture surgery from January 2015 through May 2020 at one medical center were reviewed for perioperative factors and mortality. Patients with age ≥ 70 years who were diagnosed with intertrochanteric or femoral neck fractures were included. Patients who were diagnosed with pathological fracture, received only conservative treatment or lost to follow-up were excluded. A multivariate Cox proportional hazards regression model was used to identify risk factors. A nomogram was established with R software and evaluated using concordance (C)-index, area under receiver operating characteristic (AUC), calibration curves, and decision curve analysis (DCA).
Results:
In total, 454 patients were included with a mean age of 81.6 years. The mean follow-up and one-year mortality rate were 37.2 months and 10.4%, respectively. Five identified risk variables for mortality after hip fracture surgery in geriatrics comprised age (HR 1.05, 95% CI 1.01-1.08; P = 0.003), CCI (HR 1.38, 95% CI 1.24-1.54; P = 0.000), albumin (HR 1.78, 95% CI 1.31-2.43; P = 0.000), sodium (HR 1.59, 95% CI 1.18-2.15; P = 0.002) and hemoglobin (HR 1.46, 95% CI 1.07-2.00; P = 0.02). A nomogram was proposed and evaluated, showing a C-index of 0.76 ± 0.02. The AUCs for 6-month, 1-year, and 3-year mortality predictions were 0.83, 0.79, and 0.77, respectively. The calibration curve and DCA showed good discrimination and clinical usefulness.
Conclusion:
This novel nomogram for stratifying the mortality risk after hip fracture surgery in geriatrics incorporated age, CCI, serum albumin, sodium, and hemoglobin. Internal validation indicated that the model has good accuracy and usefulness. This nomogram had improved convenience and precision compared with other models. External validation is warranted to confirm its performance.
More Related Videos
Related Concept Videos
01:15Drug Dosing: Geriatric Patients
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:23Dosage Regimen Designs: Nomograms and Tabulations