Development and temporal external validation of a novel nomogram for predicting one-year mortality in the older adult with hip fracture

Objective: The aim of this study was to develop a novel nomogram for predicting one-year mortality in the older adult patients with hip fracture and to further evaluate its effectiveness. Methods: This retrospective cohort research analyzed the clinical data of 1,263 older adult patients with hip fractures who underwent surgery at the First Affiliated Hospital of Air Force Military Medical University from January 2014 to December 2022. Patients receiving surgical treatment during January 2014 to December 2019 (864 cases) for the model development and further, data from the same centre with same inclusion criteria from January 2020 to December 2022 (399 cases) for the external validation of the model. The univariate and multivariable logistic regression were utilized to identify independent risk factors linked to one-year mortality. A predictive nomogram was subsequently developed. The discriminatory power of the model and its accuracy were monitored by utilizing receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Furthermore, visual risk applications were developed to enhance usability. Results: The one-year mortality is 16.8%. A total of seven predictors, namely age, body mass index (BMI), fibrinogen (FIB), stroke, dementia, ASA (American Society of Anesthesiologists), intraoperative blood transfusion were identified by multivariate analysis from a total of 65 variables studied. The model constructed using these seven predictors displayed medium prediction ability, with an area under the ROC of 0.775 in the training set and 0.740 in the validation set. The calibration curve shows a good degree of fitting between the predicted and observed probabilities. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 8 and 64%, which was found to be between 6 and 80% in the external validation. Conclusion: Independent factors, including age, BMI, preoperative fibrinogen level, stroke, dementia, ASA, intraoperative blood transfusion are pivotal in influencing one-year survival rate for patients with hip fractures. This risk dynamic nomogram developed from these factors renders substantial predictive accuracy and clinical utility, providing a reliable basis for a reasonable and personalized treatment plan.