ASAgeCoGeCC score efficiently stratifies mid-term death risk
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Researchers evaluated mortality in a cohort of hip fracture patients and implemented a risk prediction score named ASAgeCoGeCC with excellent discrimination. It allowed to separate patients in 3 different risk groups with distinct mortality rates. Recognition of the heterogeneity of patients with femoral fractures may have relevant implications for their management. The aim of this study was to identify a predictive model that is able to determine the possible presence of distinct subgroups of hip fracture patients by risk classes in the mid-term.

323 hip fracture patients were evaluated, and mortality rates at 30 days, 1, 2, and 4 years were calculated. A multivariate logistic regression analysis using mortality 4 years after fracture as a dependent variable found, ASA score, age, cognitive status, gender, and Charlson Comorbidities Index (CCI) as significant risk factors. Using these items, a score named ASAgeCoGeCC was implemented and compared with CCI and Nottingham Hip Fracture Score (NHFS) by a receiver operating characteristic (ROC) curve.

--The area under the ROC curve for ASAgeCoGeCC was always greater than that of CCI and NHFS and ranged between 0.804 and 0.820 suggesting an excellent discrimination.

--The ASAgeCoGeCC logistic model showed also a good calibration. Patients were divided in 3 groups: a low risk group, an intermediate risk group with an odds ratio for 4-year mortality of 5.6, and a high risk group with an odds ratio 21.6.

To summarize, the ASAgeCoGeCC Score is a reliable predictor of mortality after hip fracture, with strong calibration and discrimination properties. It is the first rating method for predicting the mortality of hip fracture patients four years after the fracture.