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Published on: September 22, 2020
The modified lymphocyte C-reactive protein score is a promising indicator for predicting 3-year mortality in elderly
Zile He1,2, Chuangxin Zhang3,4, Mingzi Ran4
1Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
Insights
A new modified lymphocyte C-reactive protein (CRP) score (mLCS) effectively predicts 3-year mortality in elderly hip fracture patients. This simple score aids in assessing long-term survival after intertrochanteric fracture surgery.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Biomarkers and Diagnostics
Background:
- Hip fractures are a significant health concern in the elderly population, frequently necessitating surgical intervention.
- Assessing long-term prognosis, specifically 3-year mortality, is crucial for managing elderly patients post-intertrochanteric fracture surgery.
Purpose of the Study:
- To develop and validate a novel modified lymphocyte C-reactive protein (CRP) score (mLCS).
- To evaluate the mLCS's utility in simply and conveniently predicting 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery.
Main Methods:
- A retrospective study included 291 elderly patients who underwent intertrochanteric fracture surgery.
- The mLCS was derived using C-reactive protein (CRP) levels and lymphocyte counts.
- Statistical analyses, including Cox regression, C-statistics, decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI), were employed to assess predictive performance.
Main Results:
- The mLCS was significantly associated with 3-year postoperative mortality (Hazard Ratio: 5.415).
- The mLCS demonstrated superior predictive performance compared to the lymphocyte CRP score (LCS), with higher C-statistics (0.686 vs. 0.644).
- Decision curve analysis confirmed the superior clinical utility of the mLCS.
Conclusions:
- The modified lymphocyte C-reactive protein (CRP) score (mLCS) is a valuable and practical tool for predicting 3-year mortality in elderly patients with intertrochanteric fractures.
- The mLCS offers a simple yet effective method for risk stratification in this patient group.
Background:
Hip fractures are common in elderly patients, and almost all the patients undergo surgery. This study aimed to develop a novel modified lymphocyte C-reactive protein (CRP) score (mLCS) to simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery.
Methods:
A retrospective study was conducted on elderly patients who underwent intertrochanteric fracture surgery between January 2014 and December 2017. The mLCS was developed according to the value of CRP and lymphocyte counts. Univariate and multivariate Cox regression analyses were used to identify independent risk factors for 3-year mortality after surgery. The performances of the lymphocyte CRP score (LCS) and mLCS to predict 3-year mortality were then compared using C-statistics, decision curve analysis (DCA), net reclassification index (NRI) and integrated discrimination improvement (IDI).
Results:
A total of 291 patients were enrolled, of whom 52 (17.9%) died within 3 years after surgery. In the multivariate Cox regression analysis, mLCS (hazard ratio (HR), 5.415; 95% confidence interval (CI), 1.743-16.822; P = 0.003) was significantly associated with postoperative 3-year mortality. The C-statistics of LCS and mLCS for predicting 3-year mortality were 0.644 and 0.686, respectively. The NRI (mLCS vs. LCS, 0.018) and IDI (mLCS vs. LCS, 0.017) indicated that the mLCS performed better than the LCS. DCA also showed that mLCS had a higher clinical net benefit.
Conclusions:
mLCS is a promising predictor that can simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery.
