Development and validation of a nomogram for predicting in-hospital mortality in patients with nonhip femoral fractures

Abstract

Background The incidence of nonhip femoral fractures is gradually increasing, but no studies have explored the risk factors for in-hospital death in patients with nonhip femoral fractures in the ICU or developed mortality prediction models. Therefore, we chose to study this specific patient group, hoping to help clinicians improve the prognosis of patients.Methods The ROC curve was drawn, and the AUC, NRI and IDI were calculated to evaluate the discrimination of the model. The consistency between the actual probability and the predicted probability was assessed by the calibration curve and HL test. DCA was performed, and the nomogram was compared with the scoring system commonly used in clinical practice to evaluate the clinical net benefit.Results The least absolute shrinkage and selection operator (LASSO) regression analysis showed that heart rate, temperature, red blood cell distribution width, blood urea nitrogen, GCS, SA PSII, Charlson comorbidity index and cerebrovascular disease were independent risk factors for in-hospital death in patients with nonhip femoral fractures. The areas under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification index (NRI) of our model in the training set and validation set were better than those of the GCS and SAPSII scoring systems. The calibration curve and HL test results showed that our model prediction results were in good agreement with the actual results (P = 0.833 for the HL test of the training set and P = 0.767 for the HL test of the validation set). Decision curve analysis (DCA) showed that our model had a better clinical net benefit than the GCS and SAPSII scoring systems..Conclusion In this study, the independent risk factors for in-hospital death in patients with nonhip femoral fractures were determined, and a prediction model was constructed. The results of this study may help to improve the clinical prognosis of patients with nonhip femoral fractures.