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01.12.2023 | Original Article

Prognostic factors and prediction model for 1-year mortality after proximal humeral fracture

verfasst von: Bastiaan Van Grootven, Sigrid Janssens, Laurence De Keyser, Jens Voortmans, Stefaan Nijs, Johan Flamaing, Marian Dejaeger

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2023

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Abstract

Summary

The goal was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality after proximal humeral fracture (PHF). A clinical prediction model showed that the combination of 6 pre-fracture characteristics demonstrated good predictive properties for mortality within 1 year of PHF.

Introduction

Proximal humeral fractures (PFH) are the third most common major non-vertebral osteoporotic fractures in older persons and result in an increased mortality risk. The aim of this study was to investigate if patient characteristics can be used to predict 1-year post-fracture mortality.

Methods

Retrospective study with 261 patients aged 65 and older who were treated for a PHF in University Hospitals Leuven between 2016 and 2018. Baseline variables including demographics, residential status, and comorbidities were collected. The primary outcome was 1-year mortality. A clinical prediction model was developed using LASSO regression and validated using split sample and bootstrapping methods. The discrimination and calibration were evaluated.

Results

Twenty-seven (10.3%) participants died within 1-year post-PHF. Pre-fracture independent ambulation (p < 0.001), living at home at time of fracture (p < 0.001), younger age (p = 0.006), higher BMI (p = 0.012), female gender (p = 0.014), and low number of comorbidities (p < 0.001) were predictors for 1-year survival. LASSO regression identified 6 stable predictors for a prediction model: age, gender, Charlson comorbidity score, BMI, cognitive impairment, and pre-fracture nursing home residency. The discrimination was 0.891 (95% CI, 0.833 to 0.949) in the training sample, 0.878 (0.792 to 0.963) in the validation sample and 0.756 (0.636 to 0.876) in the bootstrapping samples. A similar performance was observed for patients with and without surgery. The developed model demonstrated good calibration.

Conclusions

The combination of 6 pre-fracture characteristics demonstrated good predictive properties for mortality within 1 year of PHF. These findings can guide PHF treatment decisions.

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Benzinger P et al (2019) Risk of institutionalization following fragility fractures in older people. Osteoporos Int 30:1363–1370. https://doi.org/10.1007/s00198-019-04922-xCrossRefPubMed

Kim SM et al (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50:1343–1350. https://doi.org/10.1016/j.bone.2012.02.633CrossRefPubMed

Cosman F et al (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381. https://doi.org/10.1007/s00198-014-2794-2CrossRefPubMedPubMedCentral

Willers C et al (2022) Osteoporosis in Europe: a compendium of country-specific reports. Arch Osteoporos 17:23. https://doi.org/10.1007/s11657-021-00969-8CrossRefPubMedPubMedCentral

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697. https://doi.org/10.1016/j.injury.2006.04.130CrossRefPubMed

Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Moller M (2016) Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. BMC Musculoskelet Disord 17:159. https://doi.org/10.1186/s12891-016-1009-8CrossRefPubMedPubMedCentral

Lanting B, MacDermid J, Drosdowech D, Faber KJ (2008) Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg 17:42–54. https://doi.org/10.1016/j.jse.2007.03.016CrossRefPubMed

Launonen AP et al (2015) Epidemiology of proximal humerus fractures. Arch Osteoporos 10:209. https://doi.org/10.1007/s11657-015-0209-4CrossRefPubMed

Dauwe J, Danker C, Herteleer M, Vanhaecht K, Nijs S (2022) Proximal humeral fracture osteosynthesis in Belgium: a retrospective population-based epidemiologic study. Eur J Trauma Emerg Surg 48:4509–4514. https://doi.org/10.1007/s00068-020-01466-2CrossRefPubMed

10.

Adam J, Basil Ammori M, Isah I, Jeyam M, Butt U (2020) Mortality after inpatient stay for proximal humeral fractures. J Shoulder Elbow Surg 29:e22–e28. https://doi.org/10.1016/j.jse.2019.05.030CrossRefPubMed

11.

Myeroff CM, Anderson JP, Sveom DS, Switzer JA (2018) Predictors of mortality in elder patients with proximal humeral fracture. Geriatr Orthop Surg Rehabil 9:2151458517728155. https://doi.org/10.1177/2151458517728155CrossRefPubMed

12.

Balasubramanian A et al (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30:79–92. https://doi.org/10.1007/s00198-018-4732-1CrossRefPubMed

13.

Chen W et al (2018) Comorbidities only account for a small proportion of excess mortality after fracture: a record linkage study of individual fracture types. J Bone Miner Res 33:795–802. https://doi.org/10.1002/jbmr.3374CrossRefPubMed

14.

Tran T et al (2018) Persistence of excess mortality following individual nonhip fractures: a relative survival analysis. J Clin Endocrinol Metab 103:3205–3214. https://doi.org/10.1210/jc.2017-02656CrossRefPubMed

15.

Handoll HH, Brorson S (2015) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev, CD000434. https://doi.org/10.1002/14651858.CD000434.pub4

16.

Wang MQ, Youssef T, Smerdely P (2018) Incidence and outcomes of humeral fractures in the older person. Osteoporos Int 29:1601–1608. https://doi.org/10.1007/s00198-018-4500-2CrossRefPubMed

17.

Clement ND, Duckworth AD, McQueen MM, Court-Brown CM (2014) The outcome of proximal humeral fractures in the elderly: predictors of mortality and function. Bone Joint J 96-B:970–977. https://doi.org/10.1302/0301-620X.96B7.32894CrossRefPubMed

18.

Xu BY, Yan S, Low LL, Vasanwala FF, Low SG (2019) Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord 20:568. https://doi.org/10.1186/s12891-019-2950-0CrossRefPubMedPubMedCentral

19.

Hjelholt TJ et al (2022) Development and validation of a model for predicting mortality in patients with hip fracture. Age and Ageing 51(1). https://doi.org/10.1093/ageing/afab233

20.

Rushton PRP, Reed MR, Pratt RK (2015) Independent validation of the Nottingham Hip Fracture Score and identification of regional variation in patient risk within England. Bone Joint J 97b:100–103. https://doi.org/10.1302/0301-620x.97b1.34670CrossRef

21.

Nijmeijer WS, Folbert EC, Vermeer M, Slaets JP, Hegeman JH (2016) Prediction of early mortality following hip fracture surgery in frail elderly: The Almelo Hip Fracture Score (AHFS). Injury 47:2138–2143. https://doi.org/10.1016/j.injury.2016.07.022CrossRefPubMed

22.

Müller ME, Nazarian S, Koch P, Schatzker J (2012) The comprehensive classification of fractures of long bones. Springer Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-61261-9

23.

Curtin PB et al (2022) Morbidity and mortality of fragility proximal humerus fractures: a retrospective cohort study of patients presenting to a level one trauma center. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2022.03.006CrossRefPubMed

24.

Meyer S (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284CrossRef

25.

Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251. https://doi.org/10.1016/0895-4356(94)90129-5CrossRefPubMed

26.

https://www.ksz-bcss.fgov.be/nl/documentation/webservices/personhistory.

27.

Morri M et al (2019) One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study. Sci Rep 9:18718. https://doi.org/10.1038/s41598-019-55196-6CrossRefPubMedPubMedCentral

28.

Zhang CH, Huang J (2008) The sparsity and bias of the lasso selection in high-dimensional linear regression. Ann Stat 36:1567–1594. https://doi.org/10.1214/07-Aos520CrossRef

29.

Harrell F Jr (2015) Regression modelling strategies. With applications to linear models, logistic and ordinal regression, and survival analysis, 2nd edn. Spinger International Publishing, Berlin, pp 114–115

30.

Bergdahl C, Wennergren D, Ekelund J, Moller M (2020) Mortality after a proximal humeral fracture. Bone Joint J, 1–7, https://doi.org/10.1302/0301-620X.102B9.BJJ-2020-0627.R1

31.

Kim SH, Szabo RM, Marder RA (2012) Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res 64:407–414. https://doi.org/10.1002/acr.21563CrossRef

32.

Olsson C, Petersson CJ (2006) Clinical importance of comorbidity in patients with a proximal humerus fracture. Clin Orthop Relat Res 442:93–99. https://doi.org/10.1097/01.blo.0000194673.56764.0eCrossRefPubMed

33.

Maggi S et al (2010) A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int 21:223–231. https://doi.org/10.1007/s00198-009-0936-8CrossRefPubMed

Titel: Prognostic factors and prediction model for 1-year mortality after proximal humeral fracture
verfasst von: Bastiaan Van Grootven
Sigrid Janssens
Laurence De Keyser
Jens Voortmans
Stefaan Nijs
Johan Flamaing
Marian Dejaeger
Publikationsdatum: 01.12.2023
Verlag: Springer London
Erschienen in: Archives of Osteoporosis / Ausgabe 1/2023
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-023-01260-8

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Prognostic factors and prediction model for 1-year mortality after proximal humeral fracture

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Introduction

Methods

Results

Conclusions

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