Analysis of the risk factors of mortality in elderly patients with hip fracture using a combined database of medical and long-term care insurance claims data

The heart rate on admission was associated with the mortality in elderly patients with hip fractures: a retrospective cohort study from a trauma centre in northwestern China

OBJECTIVES

To evaluate the association between heart rate on admission and mortality in elderly patients with hip fractures.

DESIGN

A retrospective cohort study.

SETTING

At a trauma centre in northwestern China.

PARTICIPANTS

Elderly patients with hip fractures.

RESULTS

This cohort study included 2006 patients who met the study criteria. The mean heart rate at admission was 81.77±15.63 beats per minute. During follow-up, 189 patients died for all-cause reasons in 1 year. Age, coronary heart disease, cancer, dementia and time to operation were introduced in multivariate regression analysis. Multivariate logistic regression showed that heart rate was associated with mortality in geriatric patients with hip fracture (OR=1.01, 95% CI 1.00 to 1.02, p=0.0242). However, the linear association was unstable, and we found a nonlinear one. In the nonlinear association, the inflection point was 84 beats per minute. If below this threshold, each 1 beat per minute increase in heart rate was associated with a 4% increase in the risk of death (OR=1.04, 95% CI 1.01 to 1.06, p=0.0017). If greater than this threshold, the risk of death peaked and was not associated with the heart rate (OR=1.00, 95% CI 0.98 to 1.01, p=0.6691).

CONCLUSION

In conclusion, the heart rate was nonlinearly associated with 1-year mortality in geriatric patients with hip fractures. The low heart rate on admission was associated with low 1-year mortality. When the heart rate was over 84 beats per minute, the risk of death peaked, and there was no association with heart rate anymore.

TRIAL REGISTRATION NUMBER

This study was registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323).

Female patients with end-stage renal failure treated by hemodialysis had a low mortality rate and small patient number compared to male patients: 5-year follow-up study in Japan

This study aimed to evaluate gender differences of hemodialysis patients in adverse events, gastrointestinal bleeding, and bone fractures during 5 year longitudinal follow-up period in the regional core hospital in Japan. This study included 151 patients with maintenance hemodialysis for end-stage renal failure at Takagi Hospital in December 2017. All the patients, divided into females-group of 61 and males-group of 90. Data were evaluated in the electronic medical record. Multivariate analysis indicated a decrease in diabetes mellitus (odd ratio: 2.3, 95% confidence interval: 1.1-4.8, p = 0.03) and less mortality in those younger than 75 years old (odd ratio: 0.2, 95% confidence interval: 0.1-0.8, p = 0.02) were characterized factors in females. Gastrointestinal bleeding were not different between genders. Bone fractures were high in females (females: 34.4% vs males: 18.9%; p<0.03), whereas the mortality rate of bone fractured patients was markedly high in males (females: 28.6% vs males: 76.5%; p = 0.003) with lower body bone fractures. In conclusion, diabetes mellitus-induced end-stage renal failure was less common in females. The mortality rate during hemodialysis was higher in males less than 75 years old with increased mortality with lower bone fractures.

The association between preoperative serum cholinesterase and all-cause mortality in geriatric patients with hip fractures: a cohort study of 2387 patients

OBJECTIVE

This study is to evaluate the association between preoperative cholinesterase levels and all-cause mortality in geriatric hip fractures.

METHODS

Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative cholinesterase levels and mortality in these patients. Analyses were performed using EmpowerStats and the R software.

RESULTS

Two thousand three hundred eighty-seven patients were included in this study. The mean follow-up period was 37.64 months. Seven hundred eighty-seven (33.0%) patients died due to all-cause mortality. Preoperative cholinesterase levels were 5910 ± 1700 U/L. Linear multivariate Cox regression models showed that preoperative cholinesterase level was associated with mortality (HR = 0.83, 95% CI: 0.78-0.88), P < 0.0001) for every 1000 U/L. However, the linear association was unstable, and nonlinearity was identified. A cholinesterase concentration of 5940 U/L was an inflection point. When preoperative cholinesterase level < 5940 U/L, the mortality decreased by 28% for every 1000 U/L increase in cholinesterase (HR = 0.72, 95%CI: 0.66-0.79, P < 0.0001). When cholinesterase was > 5940 U/L, the mortality was no longer decreased with the rise of cholinesterase (HR = 1.01, 95%CI: 0.91-1.11, P = 0.9157). We found the nonlinear association was very stable in the propensity score-matching sensitive analysis.

CONCLUSIONS

Preoperative cholinesterase levels were nonlinearly associated with mortality in elderly hip fractures, and cholinesterase was a risk indicator of all-cause mortality.

TRIAL REGISTRATION

This study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323) (08/03/2022).

The association between prealbumin concentration at admission and mortality in elderly patients with hip fractures: a cohort study

Malnutrition is associated with complications and mortality in patients of hip fracture. Prealbumin may be more suitable than albumin to accurately predict the prognosis of hip fracture in elderly patients. We found that prealbumin concentration was nonlinearly associated with mortality in elderly patients with hip fracture, and an inflection point effect was observed.

OBJECTIVE

To evaluate the association between prealbumin concentration at admission and mortality in elderly patients with hip fractures.

METHODS

Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between prealbumin concentration at admission and mortality. All analyses were performed using EmpowerStats and the R software.

RESULTS

This cohort study included 2387 patients who met the study criteria. The mean follow-up was 37.64 months. The prealbumin concentration was 162.67 ± 43.2 mg/L. Multivariate Cox regression showed that prealbumin concentration was associated with mortality in geriatric patients with hip fracture (hazard ratio [HR] = 0.95, 95% confidence intervals [CI]: 0.93-0.97, P < 0.0001). In addition, an inflection point effect was observed in the nonlinear association. The inflection point was 162.2 mg/L. If it is less than this inflection point, then every 10 mg/L increase in prealbumin was associated with a 7% reduction in the risk of death (HR = 0.93, 95%CI: 0.90-0.96, P < 0.0001). When greater than the inflection point, there was no difference in the risk of death (HR = 0.99, 95%CI: 0.95-1.03, P = 0.5127).

CONCLUSION

The prealbumin concentrations at admission were nonlinearly associated with long-term mortality in geriatric hip fractures, and 162.2 mg/L could be considered a prognostic factor of mortality risk.

Gastrointestinal bleeding among 151 patients undergoing maintenance hemodialysis for end-stage renal failure: A 5-year follow-up study

Gastrointestinal bleeding is one serious complication of patients undergoing hemodialysis with end-stage renal failure. The present study aimed to evaluate risks and clinical features of real-world clinical data on upper and lower gastrointestinal bleeding in patients undergoing hemodialysis during a 5-year longitudinal observation period. This study included 151 patients undergoing maintenance hemodialysis at Takagi Hospital between December 2017 and December 2022. Clinical data from December 2017 were recorded, and upper and lower gastrointestinal bleeding, mortality, prescribed medications, and bone fractures were examined during the five-year observation period. Of 151 patients, 32 (21.2%:4.2% per year) experienced bleeding, 24 had upper gastrointestinal bleeding, 7 had lower gastrointestinal bleeding, and one had an unknown origin of bleeding. Ulcers or erosions primarily cause upper gastrointestinal bleeding without Helicobacter pylori infection, whereas patients with H pylori eradication are more likely to experience bleeding caused by vascular lesions, often accompanied by underlying comorbidities. The prophylactic effects of proton pump inhibitors and histamine-2 receptor blockers were limited in hemodialysis patients, as 15 out of 24 patients with upper gastrointestinal bleeding (62.5%) were prescribed these medications. The mortality rate in patients with lower gastrointestinal bleeding (71.4%) was higher than that in those without bleeding (33.6%) (P < .05). All patients with lower gastrointestinal bleeding were prescribed nonsteroidal anti-inflammatory drugs and/or aspirin. In this study, endoscopic hemostasis was successfully achieved. The present study indicated that the incidence of gastrointestinal bleeding during hemodialysis was relatively high. Upper gastrointestinal bleeding may develop even with the prescription of proton pump inhibitors. Lower gastrointestinal bleeding was a complication in hemodialysis patients under serious pathological condition with nonsteroidal anti-inflammatory drugs and or aspirin.

Atrial fibrillation and mortality after ischemic stroke: An observational study using an insurance claim database

OBJECTIVES

In this study, we aimed to examine the association between atrial fibrillation and mortality after ischemic stroke and evaluate the use of anticoagulation therapy for atrial fibrillation before stroke onset in patients who experienced stroke.

METHODS

In this retrospective observational study, we used a combined database of medical and long-term care insurance claims data from one prefecture in Japan. The data of 25,352 patients aged ≥ 65 years who were hospitalized in acute care hospitals with a diagnosis of ischemic stroke between April 2012 and March 2015 were extracted. Cox proportional hazard modeling, with adjustment for age, sex, comorbidities, and long-term care dependency level (based on the activities of daily living), was performed to evaluate the relationship between mortality and atrial fibrillation.

RESULTS

The prevalence of atrial fibrillation was 21.8% in the study population. A significant association was noted between mortality and atrial fibrillation (adjusted hazard ratio: 1.28, 95% confidence interval: 1.16-1.41, p < 0.001). Anticoagulant drugs were used in 32.2% of the patients with atrial fibrillation.

CONCLUSIONS

These results indicate that atrial fibrillation is associated with mortality after stroke; however, the use of anticoagulation therapy for atrial fibrillation is unsatisfactory. Efforts to improve the use of atrial fibrillation therapy are required in Japan.

The association between hemoglobin at admission and mortality of older patients with hip fracture: a mean 3-year follow-up cohort study

BACKGROUND

Hip fracture patients often have a large drop in hemoglobin (Hgb) concentration that is associated with the initial trauma. However, there is no study of a correlation between Hgb concentration at admission and short-term mortality. Thus, we evaluated a possible linear and nonlinear association between Hgb and mortalityfor older patients with hip fracture.

METHODS

Consecutive older patients who had hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify association between Hgb at admission and mortality. All analyses were performed with EmpowerStats and R software.

RESULTS

Two thousand five hundred eighty-nine patients were included in the study. There were 849 men and 1740 women. The mean age was 79.6 ± 6.8 years. The mean follow-up was 39.0 months. Nine hundred seven (35.0%) patients died for all-cause reasons. The mean Hgb at admission was 11.07 ± 1.95 g/dL. Linear multivariate Cox regression models showed Hgb at admission was associated with mortality ([Hazard Ratio] HR 0.91, 95% CI 0.87-0.95, P < 0.0001) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was found between Hgb at admission and mortality. The Hgb concentration of 9.8 g/dL was an inflection point. A Hgb at admission < 9.8 g/dL was associated with mortality (HR 0.81, 95% CI 0.74-0.89, P < 0.0001), whereas > 9.8 g/dL was not a risk factor for mortality (HR 0.98, 95% CI 0.92-1.04, P = 0.4730).

CONCLUSIONS

The Hgb concentration at admission was nonlinearly associated with mortality of older patients with hip fracture, and Hgb at admission < 9.8 g/dL was a risk predictor of 3-year mortality.

RESEARCH REGISTRATION

ChiCTR2200057323.