Options
Exploring Prognostic Factors for Hip Fracture Outcomes in the Geriatric Population
Other Title
Exploring Prognostic Factors for Hip Fracture Outcomes in the Geriatric Population
Type
thesis
Date Issued
2025-06-21
Author(s)
Nguyen Tu Thai Bao
Advisor
陳昱斌
Subjects
系所名稱：國際醫學研究博士學位學程
Publisher
國際醫學研究博士學位學程
Description
學位別：博士
口試委員：曾峰毅; 林宗瑩; 郭宜潔; 陳加憲; 陳昱斌
關鍵字：hip fracture、geriatrics、mortality、predictor、inflammatory biomarker、red blood cell distribution width
口試委員：曾峰毅; 林宗瑩; 郭宜潔; 陳加憲; 陳昱斌
關鍵字：hip fracture、geriatrics、mortality、predictor、inflammatory biomarker、red blood cell distribution width
Abstract
Background: Hip fractures represent one of the most severe and disabling injuries in the elderly, frequently leading to long-term functional decline, reduced mobility, lower quality of life (QoL), and increased mortality risk. Identifying the factors that affect survival is essential for enhancing patient care and optimizing long-term outcomes.
Objectives: This thesis explores prognostic factors influencing mortality after hip fractures in the elderly through two complementary studies.
Materials and Methods: Study 1 was a meta-analysis examining the relationship between red blood cell distribution width (RDW) and mortality following hip fractures. It compared mortality rates between individuals with high and normal RDW, as well as RDW differences between survivors and deceased. Study 2 was a prospective cohort study that included 500 hip fracture patients to identify predictors of one-year mortality after surgery, with a focus on the implementation of inflammatory biomarkers. Multivariate logistic and Cox regression analyses were performed to determine factors associated with one-year mortality.
Results: In the first study, a total of 12 studies involving 6,867 hip fracture patients, with a pooled mean age of 87.35, showed that women (n = 4,289, 62.46%) were more prevalent than men (n = 2,578, 37.54%). Patients with a high baseline RDW level independently predicted higher mortality risk than those with a normal RDW value (pooled adjusted odds ratio: 3.40, 95% CI: 2.14-5.38, p < 0.001). High RDW also led to a higher risk of mortality over time in patients with hip fractures than normal RDW (pooled adjusted hazard ratio (HR): 1.37, 95% CI: 1.09-1.72, p = 0.007). Patients who survived after hip fractures had a lower RDW level than those who died (mean difference: -0.97, 95% CI: -1.61 to -0.33, p < 0.001). The second study evaluated 500 patients with hip fractures (149 males, 351 females; mean age: 81.05), reporting a one-year mortality rate of 11.6%. This study confirmed that older age (HR: 1.05, 95% CI: 1.01-1.09, p = 0.011), male sex (HR: 2.45, 95% CI: 1.38-4.33, p = 0.002), and higher Charlson Comorbidity Index scores (HR: 1.26, 95% CI: 1.09-1.45, p = 0.001) were significant predictors of one-year mortality and further supported RDW (HR: 1.25, 95% CI: 1.08-1.43, p = 0.002) as a valuable prognostic marker.
Conclusion: This thesis underscores the multifactorial nature of outcomes following hip fractures in the elderly. Common predictors such as advanced age, male sex, and greater morbidity burden continue to significantly elevate mortality risk. Moreover, we highlighted the prognostic value of RDW, an inflammatory biomarker, in assessing mortality risk following hip fractures.
Objectives: This thesis explores prognostic factors influencing mortality after hip fractures in the elderly through two complementary studies.
Materials and Methods: Study 1 was a meta-analysis examining the relationship between red blood cell distribution width (RDW) and mortality following hip fractures. It compared mortality rates between individuals with high and normal RDW, as well as RDW differences between survivors and deceased. Study 2 was a prospective cohort study that included 500 hip fracture patients to identify predictors of one-year mortality after surgery, with a focus on the implementation of inflammatory biomarkers. Multivariate logistic and Cox regression analyses were performed to determine factors associated with one-year mortality.
Results: In the first study, a total of 12 studies involving 6,867 hip fracture patients, with a pooled mean age of 87.35, showed that women (n = 4,289, 62.46%) were more prevalent than men (n = 2,578, 37.54%). Patients with a high baseline RDW level independently predicted higher mortality risk than those with a normal RDW value (pooled adjusted odds ratio: 3.40, 95% CI: 2.14-5.38, p < 0.001). High RDW also led to a higher risk of mortality over time in patients with hip fractures than normal RDW (pooled adjusted hazard ratio (HR): 1.37, 95% CI: 1.09-1.72, p = 0.007). Patients who survived after hip fractures had a lower RDW level than those who died (mean difference: -0.97, 95% CI: -1.61 to -0.33, p < 0.001). The second study evaluated 500 patients with hip fractures (149 males, 351 females; mean age: 81.05), reporting a one-year mortality rate of 11.6%. This study confirmed that older age (HR: 1.05, 95% CI: 1.01-1.09, p = 0.011), male sex (HR: 2.45, 95% CI: 1.38-4.33, p = 0.002), and higher Charlson Comorbidity Index scores (HR: 1.26, 95% CI: 1.09-1.45, p = 0.001) were significant predictors of one-year mortality and further supported RDW (HR: 1.25, 95% CI: 1.08-1.43, p = 0.002) as a valuable prognostic marker.
Conclusion: This thesis underscores the multifactorial nature of outcomes following hip fractures in the elderly. Common predictors such as advanced age, male sex, and greater morbidity burden continue to significantly elevate mortality risk. Moreover, we highlighted the prognostic value of RDW, an inflammatory biomarker, in assessing mortality risk following hip fractures.