Top

Published in:

07-12-2023 | Anemia | Original Article

A prediction model of elderly hip fracture mortality including preoperative red cell distribution width constructed based on the random survival forest (RSF) and Cox risk ratio regression

Authors: Ying-feng Zhou, Jiao Wang, Xin-lin Wang, Shu-shu Song, Yue Bai, Jian-lin Li, Jing-yu Luo, Qi-qi Jin, Wei-cha Cai, Kai-ming Yuan, Jun Li

Published in: Osteoporosis International | Issue 4/2024

Abstract

Summary

An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients. With further research, a treatment algorithm can be developed to potentially identify patients at high risk of preoperative mortality.

Introduction

Red blood cell distribution width (RDW) is an independent predictor of various disease states in elderly individuals, but its association with the prognosis of elderly hip fracture patients is controversial. This study aimed to evaluate the prognostic value of RDW in such patients, construct a prediction model containing RDW using random survival forest (RSF) and Cox regression analysis, and compare RDW in patients with and without anemia.

Methods

We retrospectively analyzed the data of elderly patients who underwent hip fracture surgery, selected the best variables using RSF, stratified the independent variables by Cox regression analysis, constructed a 1-year mortality prediction model of elderly hip fracture with RDW, and conducted internal validation and external validation.

Results

Two thousand one hundred six patients were included in this study. The RSF algorithm selects 12 important influencing factors, and Cox regression analysis showed that eight variables including preoperative RDW (pre-RDW) were independent risk factors for death within 1-year after hip fracture surgery in elderly patients. Stratified analysis showed that pre-RDW was still independently associated with 1-year mortality in the non-anemia group and not in the anemia group. The nomogram prediction model had high differentiation and fit, and the prediction model constructed by the total cohort of patients was also used for validation of patients in the anemia patients and obtained good clinical benefits.

Conclusion

Available only for authorised users

Amen TB, Varady NH, Hayden BL et al (2020) Pathologic versus native hip fractures: comparing 30-day mortality and short-term complication profiles. J Arthroplast 35:1194–1199CrossRef

Coburn M, Sanders RD, Maze M et al (2018) The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the prevention of postoperative delirium: a multicentre, randomized clinical trial. Br J Anaesth 120:127–137CrossRefPubMed

Ishwaran H, Gerds TA, Kogalur UB et al (2014) Random survival forests for competing risks. Biostatistics 15:757–773CrossRefPubMedPubMedCentral

Seo IH, Lee YJ (2022) Usefulness of complete blood count (CBC) to assess cardiovascular and metabolic diseases in clinical settings: a comprehensive literature review. Biomedicines 10 undefined

Liu J, Ma Y, Xie W et al (2023) Lasso-based machine learning algorithm for predicting postoperative lung complications in elderly: a single-center retrospective study from China. Clin Interv Aging 18:597–606CrossRefPubMedPubMedCentral

Li Y, Chen M, Lv H et al (2021) A novel machine-learning algorithm for predicting mortality risk after hip fracture surgery. Injury 52:1487–1493CrossRefPubMed

Li L, Sun G, Yu J et al (2023) Identification of predictors for the comprehensive clinical risk and severity of coronary lesions of acute coronary syndrome. Front Cardiovasc Med 10:1046895CrossRefPubMedPubMedCentral

Garbharran U, Chinthapalli S, Hopper I et al (2013) Red cell distribution width is an independent predictor of mortality in hip fracture. Age Ageing 42:258–261CrossRefPubMed

Zehir S, Sipahioğlu S, Ozdemir G et al (2014) Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis. Acta Orthop Traumatol Turc 48:141–146CrossRefPubMed

10.

Aali-Rezaie A, Alijanipour P, Shohat N et al (2018) Red cell distribution width: an unacknowledged predictor of mortality and adverse outcomes following revision arthroplasty. J Arthroplast 33:3514–3519CrossRef

11.

Kim K, Nerlekar R, Tranah GJ et al (2022) Higher red cell distribution width and poorer hospitalization-related outcomes in elderly patients. J Am Geriatr Soc 70:2354–2362CrossRefPubMed

12.

Sanford K, Case N, Blake B et al (2020) Changes in Mean corpuscular volume and RBC distribution width predict erythrocyte engraftment following ABO-incompatible hematopoietic stem cell transplantation. Am J Clin Pathol 153:781–789CrossRefPubMed

13.

Kayacık Günday Ö, Özdemir Erdoğan M, Pehlivan A et al (2022) The effect of metformin treatment on leukocyte telomere length in patients with polycystic ovary syndrome: a prospective case-control study. J Assist Reprod Genet 39:2153–2161CrossRefPubMedPubMedCentral

14.

Balistreri CR, Pisano C, Bertoldo F et al (2019) Red blood cell distribution width, vascular aging biomarkers, and endothelial progenitor cells for predicting vascular aging and diagnosing/prognosing age-related degenerative arterial diseases. Rejuvenation Res 22:399–408CrossRefPubMed

15.

Jelkmann W (1998) Proinflammatory cytokines lowering erythropoietin production. J Interferon Cytokine Res 18:555–559CrossRefPubMed

16.

Wacka E, Wawrzyniak-Gramacka E, Tylutka A et al (2023) The role of inflammation in age-associated changes in red blood system. Int J Mol Sci 24 undefined

17.

Brzeźniakiewicz-Janus K, Rupa-Matysek J, Tukiendorf A et al (2020) Red blood cells mean corpuscular volume (MCV) and red blood distribution width (RDW) parameters as potential indicators of regenerative potential in older patients and predictors of acute mortality - preliminary report. Stem Cell Rev Rep 16:711–717CrossRefPubMedPubMedCentral

18.

May JE, Marques MB, Reddy VVB et al (2019) Three neglected numbers in the CBC: the RDW, MPV, and NRBC count. Cleve Clin J Med 86:167–172CrossRefPubMed

19.

Xanthopoulos A, Giamouzis G, Dimos A et al (2022) Red blood cell distribution width in heart failure: pathophysiology, prognostic role, controversies and dilemmas. J Clin Med 11 undefined

20.

Babaoglu E, Ulasli SS (2023) Clinical importance of red cell distribution width and red cell index in pulmonary embolism. Eur Rev Med Pharmacol Sci 27:4108–4115PubMed

21.

Lv H, Zhang L, Long A et al (2016) Red cell distribution width as an independent predictor of long-term mortality in hip fracture patients: a prospective cohort study. J Bone Miner Res 31:223–233CrossRefPubMed

22.

Marom O, Paz I, Topaz G et al (2022) Red cell distribution width-a mortality predictor in older adults with proximal femoral fracture. Arch Gerontol Geriatr 100:104623CrossRefPubMed

23.

Hamdan M, Haddad BI, Jabaiti M et al (2021) Does red cell distribution width predict hip fracture mortality among the Arab population? A single-center retrospective cohort study. Int J Gen Med 14:10195–10202CrossRefPubMedPubMedCentral

24.

Akcal MA, Eke I (2021) Post-operative red cell distribution width increase may predict mortality in patients operated for hip fracture. Clin Lab 67 undefined

25.

Wei-Hsiang H, Zhu Y, Zhang J et al (2021) Pretreatment red blood cell distribution width as an efficient predictor of survival in older patients undergoing hip fracture surgery. Int J Clin Pract 75:e14791CrossRefPubMed

26.

Yin P, Lv H, Zhang L et al (2016) Combination of red cell distribution width and American Society of Anesthesiologists score for hip fracture mortality prediction. Osteoporos Int 27:2077–2087CrossRefPubMed

27.

Kim KM, Lui LY, Cauley JA et al (2020) Red cell distribution width is a risk factor for hip fracture in elderly men without anemia. J Bone Miner Res 35:869–874CrossRefPubMed

28.

Hoffmann JJML, Urrechaga E (2020) Role of RDW in mathematical formulas aiding the differential diagnosis of microcytic anemia. Scand J Clin Lab Invest 80:464–469CrossRefPubMed

29.

Zhang L, Yin P, Lv H et al (2016) Anemia on admission is an independent predictor of long-term mortality in hip fracture population: a prospective study with 2-year follow-up. Medicine. 95(5):e2469CrossRefPubMedPubMedCentral

Title: A prediction model of elderly hip fracture mortality including preoperative red cell distribution width constructed based on the random survival forest (RSF) and Cox risk ratio regression
Authors: Ying-feng Zhou
Jiao Wang
Xin-lin Wang
Shu-shu Song
Yue Bai
Jian-lin Li
Jing-yu Luo
Qi-qi Jin
Wei-cha Cai
Kai-ming Yuan
Jun Li
Publication date: 07-12-2023
Publisher: Springer London
Keyword: Anemia
Published in: Osteoporosis International / Issue 4/2024
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-023-06988-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A prediction model of elderly hip fracture mortality including preoperative red cell distribution width constructed based on the random survival forest (RSF) and Cox risk ratio regression

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2024

Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery

Higher risk of osteoporosis in adult-onset asthma than childhood-onset asthma: from genetic and prospective evidence

Epidemiology of forearm fractures in women and men in Norway 2008–2019

Hypophosphatasia: presentation and response to asfotase alfa

Falsely elevated parathyroid hormone in a patient with osteoporosis: a case report and review

Trajectories of oral bisphosphonate use after hip fractures: a population-based cohort study