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Published on: August 17, 2017
The Effect of Hematocrit on All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study
Yu-Min Zhang1, Kun Li1, Wen-Wen Cao1
1Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an 710054, China.
Insights
Hematocrit (HCT) levels show a nonlinear association with mortality in older adults with hip fractures. Levels below 28% significantly increase mortality risk, while higher levels do not.
Area of Science:
- Geriatric Medicine
- Clinical Epidemiology
- Hematology
Background:
- Hip fractures are a significant cause of morbidity and mortality in the elderly.
- Hematocrit (HCT) levels, a measure of red blood cell concentration, may influence outcomes in this population.
- Understanding the relationship between HCT and mortality is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the association between hematocrit levels and all-cause mortality in geriatric patients who have sustained a hip fracture.
- To determine if the relationship between HCT and mortality is linear or nonlinear.
Main Methods:
- A cohort of geriatric hip fracture patients was analyzed (January 2015 - September 2019).
- Demographic and clinical data were collected.
- Linear and nonlinear multivariate Cox regression models were employed to assess the association between HCT levels and mortality, with analyses performed using EmpowerStats and R software.
Main Results:
- The study included 2589 patients with a mean follow-up of 38.94 months; 33.8% experienced all-cause mortality.
- Initially, a linear model suggested HCT was associated with mortality (HR=0.97).
- However, a nonlinear association was identified, with a HCT level of 28% serving as an inflection point. HCT <28% was linked to increased mortality (HR=0.91), while HCT >28% was not a significant risk factor (HR=0.99). This nonlinear relationship remained stable in sensitivity analyses.
Conclusions:
- Hematocrit levels exhibit a nonlinear association with mortality in geriatric hip fracture patients.
- Hematocrit levels, particularly those below 28%, can serve as a significant predictor of mortality in this vulnerable patient group.
Objective:
The present study aimed to evaluate the association between hematocrit (HCT) levels and all-cause mortality in geriatric hip fractures.
Methods:
Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of these patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between HCT levels and mortality. Analyses were performed using EmpowerStats and the R software.
Results:
A total of 2589 patients were included in this study. The mean follow-up period was 38.94 months. Eight hundred and seventy-five (33.8%) patients died due to all-cause mortality. Linear multivariate Cox regression models showed that HCT level was associated with mortality (hazard ratio [HR] = 0.97, 95% confidence interval [CI]: 0.96-0.99, p = 0.0002) after adjusting for confounding factors. However, the linear association was unstable and nonlinearity was identified. A HCT level of 28% was the inflection point for prediction. A HCT level of <28% was associated with mortality (HR = 0.91, 95% CI: 0.87-0.95, p < 0.0001), whereas a HCT level > 28% was not a risk factor for mortality (HR = 0.99, 95% CI: 0.97-1.01, p = 0.3792). We found that the nonlinear association was very stable in the propensity score-matching sensitivity analysis.
Conclusions:
The HCT level was nonlinearly associated with mortality in geriatric hip fracture patients and could be considered a predictor of mortality in these patients.
Registration:
ChiCTR2200057323.
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