Abstract: PO1691
Which Parameters Best Predict Mortality After Hip Fracture for Patients with CKD? Insights from a 6-Year Prospective Analysis
Session Information
- Advances in Geriatric Nephrology
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1100 Geriatric Nephrology
Authors
- Wu, Henry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
- Van Mierlo, Rene, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
- Dhaygude, Ajay Prabhakar, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
- Mitra, Sandip, The University of Manchester, Manchester, Manchester, United Kingdom
- Nixon, Andrew Christopher, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
Background
Hip fracture is more prevalent in patients with CKD and has associated worse clinical outcomes than those without CKD. Uncertainties remain on which clinical or laboratory parameters best predict mortality outcomes following hip fracture for patients with CKD.
Methods
Patients with CKD G3b-5 admitted to a tertiary hospital in North West UK with hip fracture between June 2013 and Dec 2019 were included. Mortality outcomes at 1st year, 3rd year and 6th year after hip fracture were assessed. Parameters assessed on hospital admission included Clinical Frailty Scale (CFS), Hopkins Frailty Score (HFS), CKD FI-LAB, Sernbo Score, Charlson's Co-morbidity Index, Nottingham Hip Fracture Score, ASA Score and Abbreviated Mental Test Score. ROC curve analyses were performed to evaluate ability of individual scoring tools to predict mortality outcomes after hip fracture.
Results
A total of 397 patients met study inclusion criteria of which 42 were receiving long-term dialysis. Mean age was 83.5±9.2 yrs. Non-dialysis patient mean eGFR was 37.4±14.9 mL/min/1.73m2. Mortality at 1, 3 and 6 years were 38% (n=151), 60% (n=239) and 77% (n=305) respectively. AUC values from ROC curve analyses are presented in Table 1.
Conclusion
Frailty assessment tools (CFS, HFS and CKD FI-LAB) had the best predictive value for short- and long-term mortality after hip fracture for patients living with CKD. A comprehensive frailty assessment should be performed on patients with CKD admitted after a hip fracture to identify those at greatest risk of adverse outcomes. Further research is needed to evaluate interventions that aim to reduce mortality risk after hip fracture for patients living with CKD.
Table 1: AUC values of tools used to predict mortality following hip fracture
| Predictor | AUC Value (1 year mortality) | 95%Cl | AUC Value (3 year mortality) | 95%Cl | AUC Value (6 year mortality) | 95%Cl |
| Clinical Frailty Scale | 0.95 | 0.89-1.00 | 0.93 | 0.87-0.99 | 0.95 | 0.89-1.00 |
| Hopkins Frailty Score | 0.91 | 0.84-0.98 | 0.91 | 0.83-0.99 | 0.93 | 0.86-1.00 |
| CKD FI-LAB | 0.86 | 0.78-0.93 | 0.87 | 0.80-0.94 | 0.90 | 0.83-0.97 |
| Sernbo Score | 0.85 | 0.78-0.92 | 0.86 | 0.79-0.93 | 0.83 | 0.76-0.90 |
| Charlson's Co-morbidity Index | 0.88 | 0.81-0.94 | 0.86 | 0.79-0.93 | 0.89 | 0.82-0.96 |
| Nottingham Hip Fracture Score | 0.85 | 0.77-0.92 | 0.83 | 0.76-0.90 | 0.80 | 0.73-0.87 |
| ASA Score | 0.74 | 0.66-0.81 | 0.75 | 0.67-0.82 | 0.78 | 0.70-0.87 |
| Abbreviated Mental Test Score | 0.60 | 0.53-0.67 | 0.59 | 0.52-0.66 | 0.64 | 0.57-0.71 |
Funding
- Government Support - Non-U.S.