查看更多>>摘要：目的 系统评价老年髋部骨折患者术后死亡风险的各预测模型。 方法 系统检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library和Web of Science，检索有关老年髋部骨折患者术后死亡风险预测模型的研究，检索时间为建库至2023年2月28日。由2名研究者独立筛选文献、提取资料，使用预测模型风险偏倚工具对纳入研究进行质量评价，采用R 4.1.1软件对数据进行Meta分析。 结果 纳入15篇研究，5篇研究为模型开发，10篇为模型开发及内部验证。15篇研究预测模型性能整体较好[曲线下面积（AUC）为0.640～0.967]，但均存在偏倚风险，可能原因是样本量过少、未报告数据缺失值的处理方法、数据复杂性、预测变量筛选方法不恰当及模型拟合问题欠考虑等。Meta分析结果显示，年龄增加[OR=1.06，95%CI（1.04～1.08），P<0.01]、男性[OR=1.92，95%CI（1.48～2.48），P<0.01]、血红蛋白减少[OR=1.53，95%CI（1.35～1.74），P<0.01]是老年髋部骨折术后死亡独立危险因素。 结论 老年髋部骨折患者术后死亡风险预测模型尚存在一定的不足。未来需要对现有模型进行优化，并对模型进行内外部验证。医护人员应重点关注高龄、男性、术后血红蛋白较低患者，提前制定针对性的干预策略。 Objective To systematically review the prediction models of postoperative mortality risk in elderly patients with hip fracture. Methods China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine disc, PubMed, Embase, Cochrane Library and Web of Science were systematically searched for studies on mortality risk prediction models after hip fracture surgery in the elderly. The search period was from establishment of the databases to February 28, 2023. Two researchers independently screened the literature, extracted the data, and used the predictive model risk bias tool to evaluate the quality of studies. R4.1.1 software was used to perform meta-analysis of the data. Results A total of 15 studies were included, of which five were for model development and ten were for model development and internal validation. The performance of the prediction models in the 15 studies was generally good (AUC: 0.640-0.967), but all of them had bias risks, mainly due to the small sample size, unreported processing methods for missing data values, data complexity, the inappropriate screening method of predictor variables and the lack of consideration of model fitting. Meta-analysis showed that age increase [OR=1.06, 95%CI (1.04, 1.08), P<0.01], male [OR=1.92, 95%CI (1.48, 2.48), P<0.01] and reduced hemoglobin [OR=1.53, 95%CI (1.35, 1.74), P<0.01] were independent risk factors for postoperative death in elderly patients with hip fracture. Conclusions The prediction model of mortality risk after hip fracture surgery in elderly patients still has shortcomings. In the future, it is necessary to optimize the existing model and verify the model internally and externally. Medical staff should focus on elderly, male, postoperative patients with low hemoglobin and formulate targeted intervention strategies in advance.
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