Construction and validation of the nomogram for prognostic risk factors in elderly hip fracture patients with previous stroke

Zhang Xiaozhou; Feng Qiming

doi:10.3969/j.issn.1002-1949.2025.06.003

Abstract：Objective To study the risk factors of adverse outcomes in elderly hip fracture patients with previous stroke history during the 90-day postoperative period and to make a nomogram to predict the risk of adverse outcomes occurrence.Methods A retrospective study on 602 elderly hip fracture patients with previous stroke underwent surgical treatments in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2017 to September 2024 was conducted and general information of the patients,including their baseline data,basic comorbidities,previous stroke histories,preoperative complications,American Society of Anesthesiologists(ASA)score,age-adjusted Charlson comorbidity index(aCCI)score and modified Rankin scale(mRS)score were collected as evaluation indicators.Then,follow-up investigation of the patients experiencing adverse outcomes such as death or severe complications was conducted,and the independent factors were analyzed before constructing the nomogram model for risk prediction by using R rms packages.Results Among all 602 patients,78 patients(12.95％)had adverse outcomes.Intertrochanteric fracture,cardiac insufficiency,infection in lungs/urinary tracts,hypoproteinemia,electrolyte imbalance and mRS＞2 scores were independent risk factors of adverse outcomes during the 90-day postoperative period of the patients[OR(95％CI)5.259(2.767-9.995),4.206(1.798-9.836),3.759(1.904-7.422),2.269(1.239-4.154),1.951(1.055-3.606),3.130(2.404-4.074)].Based on above 6 influencing factors,a nomogram was made and assessed with internal verification.The results showed the C-index was 0.901 with the 95％CI 0.868-0.934.Prediction curve was consistent with the actual incidence,the nomogram model had the good predictive ability.Conclusions Intertrochanteric fracture,cardiac insufficiency,infection in lungs/urinary tracts,hypoproteinemia,electrolyte imbalance and mRS＞2 scores are independent risk factors of adverse outcomes in elderly hip fracture patients with previous stroke during the 90-day postoperative period.The nomogram model constructed in the study is of good value in predicting the occurrence of adverse outcomes during 90 days postoperatively.