Development and validation of a nomogram for 30-day readmission after hip fracture surgery in geriatric patients

OBJECTIVE

30-day readmission after hip fracture surgery in the elderly is common and costly. A predictive tool to identify high-risk patients could significantly improve outcomes. This study aims to develop and validate a risk nomogram for 30-day readmission after hip fracture surgery in geriatric patients.

PATIENTS AND METHODS

We retrospectively analyzed 1,249 geriatric hip fracture patients (≥60 years) undergoing surgery at Dandong Central Hospital from October 2011 to October 2023. Using a 7:3 ratio, patients were randomly divided into training (n=877) and validation (n=372) sets. Independent risk factors for 30-day readmission were identified using LASSO regression and logistic regression in the training set. A nomogram was constructed using the identified predictors. Finally, the C-index, ROC curve, calibration curve, and decision curve analysis were used to validate the model in the training and validation sets respectively.

RESULTS

The nomogram was developed based on the 8 predictors of age, prior stroke, chronic liver disease, treatment, uric acid (UA), total protein (TP), albumin (ALB), and pneumonia that were found to be independently associated with 30-day readmission. The nomogram showed good discrimination with a C-index of 0.88 in the training set and 0.84 in the validation set. Calibration curves exhibited good agreement between predicted and observed outcomes. Decision curve analysis demonstrated clinical utility.

CONCLUSIONS

We developed and validated a nomogram incorporating eight clinical variables to accurately predict the individualized risk of 30-day readmission after hip fracture surgery in elderly patients. The model demonstrated favorable discrimination, calibration, and clinical utility. It can help to identify high-risk patients needing additional interventions to prevent avoidable hospital readmissions.

Development and validation of a nomogram for urinary tract infection in geriatric patients with hip fracture: a retrospective study

OBJECTIVE

This study aims to develop and validate a risk nomogram for urinary tract infections (UTIs) in geriatric patients with hip fractures.

PATIENTS AND METHODS

A total of 900 geriatric patients who underwent hip fracture surgery at Dandong Central Hospital between June 2017 and June 2023 were systematically collected. The cohort was randomly divided into a training set (70%, n=632) and a validation set (30%, n=268) for model development and validation, respectively. Univariate and multivariate logistic regression analyses were conducted to identify the independent risk factors associated with UTIs. Based on the results of the multivariate analysis, a UTI nomogram prediction model was developed and evaluated in the training and validation sets using the C-index, ROC curve, calibration curve, and decision curve analysis to assess discrimination, calibration, and clinical utility, respectively.

RESULTS

Out of the 900 participants, 24.6% were diagnosed with UTIs. The nomogram was developed based on 9 predictors that were found to be independently associated with UTI. The area under the curve (AUC) for predicting UTI in geriatric patients with hip fractures was 0.829 in the training set and 0.803 in the validation set. Following internal verification, the modified C-index remained at 0.829. Furthermore, the nomogram's calibration plot and decision curve analysis demonstrated good performance in both the training and validation sets.

CONCLUSIONS

The established and validated nomogram provides a reliable and convenient tool for predicting UTI risk in geriatric patients with hip fractures. This model facilitates the early identification of high-risk patients and offers guidance for implementing targeted preventive interventions.

Development and validation of preoperative proximal and distal lower limb deep vein thrombosis nomograms in geriatric hip fracture patients

OBJECTIVE

This study aimed to develop and validate a risk nomogram for preoperative proximal and distal deep vein thrombosis (DVT) in geriatric patients with hip fractures.

PATIENTS AND METHODS

The 970 collected geriatric hip fracture patients were randomly divided into a training set (70%, n=682) and a validation set (30%, n=288). Multivariate logistic regression analyses were used to optimize the predictive risk variables for proximal and distal preoperative lower extremity DVT in the training set, respectively, and the selected variables were finally incorporated to establish preoperative DVT nomogram prediction models. Receiver operating characteristic curves (ROC), calibration plots, and decision curve analysis (DCA) were performed to validate the nomograms in the training and validation sets, respectively.

RESULTS

Among the 970 patients, 125 (12.88%) were diagnosed with preoperative DVT. The area under the curve (AUC) for predicting preoperative proximal DVT was 0.888 in the training and 0.792 in the validation sets. The AUC for predicting preoperative distal DVT was 0.907 in the training and 0.790 in the validation sets. The calibration plots and decision curve analysis for preoperative proximal DVT performed well in the training set and slightly worse in the validation set. The calibration plots and decision curve analysis for preoperative distal DVT performed well in both the training and validation sets.

CONCLUSIONS

To construct nomograms for predicting the risk of proximal and distal preoperative lower extremity DVT in geriatric hip fracture patients. For patients at high risk, as assessed by this model, clinicians should intervene and treat them promptly before surgery.

[Advances in clinical studies of chronic cough]

Chronic cough is a common complaint in respiratory specialist clinics, with a significant impact on cough-specific quality of life and psychophysiological health. The diagnosis, treatment and management of chronic cough remains a major challenge. We summarized a series of recent advances from clinical studies in the epidemiology, diagnosis and management of chronic cough over the past year.

microRNA15b induced SMCC7721 apoptosis via down-regulation of XIAP

OBJECTIVE

microRNA can regulate cell growth, proliferation, and death; also, it can promote or inhibit cell growth and proliferation through regulation of apoptotic proteins. XIAP is a newly discovered pro-apoptotic protein, but how is XIAP regulated remains unclear. This study investigated the role of microRNA-15b in liver cancer cells' proliferation and apoptosis.

MATERIALS AND METHODS

microRNA15b and control microRNA (miRNA) were purchased and transfected with hepatoma SMCC7721 cells using liposomal transfection techniques. MTT assay, caspase-3 activity assay, and flow cytometry were used to investigate the effects of micorRNA-15b on growth, proliferation, and apoptosis of SMCC7721 cells. SiRNA of XIAP and control siRNA were purchased and transfected into SMCC7721 cells. microRNA15b and control microRNA were then transfected into siRNA of XIAP or control siRNA transfected SMCC7721 cells. Western blot analysis was used to detect the expression levels of XIAP and apoptotic proteins. XIAP plasmid and control vector were purchased and transfected into SMCC7721 cells followed by transfection of microRNA15b and control microRNA. Expression levels of XIAP and apoptosis of SMCC7721 cells were analyzed.

RESULTS

Transfection of microRNA15b reduced the growth of SMCC7721 cells, increased phosphatidylserine eversion, activated caspase-3, and decreased the expression levels of XIAP. Silence of XIAP enhanced microRNA15b-induced apoptosis of SMCC7721 cells. Overexpression of XIAP inhibited microRNA15b-induced apoptosis of SMCC7721 cells. microRNA15b inhibited the growth of SMCC7721 cells.

CONCLUSIONS

microRNA15b induced apoptosis of SMCC7721 cells via down-regulation of XIAP.