Red cell distribution width and modified 5-item frailty index to predict short-term mortality in patients undergoing surgery for hip fracture
TL;DR
RDW emerged as an independent predictor of ICU admission and 30-day mortality in surgically managed HF patients, with improved discriminatory performance when integrated into a multiparametric model, and support the incorporation of RDW into routine emergency risk stratification for this vulnerable population.
Abstract
Background
Hip fractures (HFs), which are common in the geriatric population and have a high mortality rate, are among the pathologies frequently encountered in emergency departments (EDs). The aim of this study was to investigate the prognostic value of red cell distribution width (RDW) and modified 5-item frailty index (mFI-5) scores in the prediction of short-term mortality and intensive care unit (ICU) admission in patients with HFs.
Methods
Patients who presented to the ED due to HF between January 01, 2019, and December 31, 2023, were evaluated. Patients who underwent surgery for femoral neck, intertrochanteric, or subtrochanteric fractures were included in the study. Baseline demographics (age and sex), comorbidities, ICU admission status, and in-hospital and 30-day mortality rates were recorded. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of ICU admission and 30-day mortality.
Results
A total of 413 patients undergoing surgical treatment for HFs were included. The mean age of the patients was 80±11 years, and 271 (65.6%) were female. ICU admission was required for 43 patients (10%), while in-hospital and 30-day mortality rates were 7% (n=30) and 9.9% (n=41), respectively. Multivariable logistic regression analysis identified RDW as an independent predictor of both ICU admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05–1.41; p=0.009) and 30-day mortality (OR 1.20, 95% CI 1.03–1.39; p=0.016). Atrial fibrillation (AF) and Alzheimer’s disease were also identified as independent predictors of ICU admission, while AF and age independently predicted 30-day mortality. The mFI-5 score did not reach statistical significance in univariate analysis for either outcome. A predictive model incorporating RDW and other covariates achieved area under the curve values of 0.74 for ICU admission and 0.70 for 30-day mortality.
Conclusion
RDW emerged as an independent predictor of ICU admission and 30-day mortality in surgically managed HF patients, with improved discriminatory performance when integrated into a multiparametric model. Advanced age, Alzheimer’s disease, and AF further contribute to increased risk and should be closely monitored in clinical management. These findings support the incorporation of RDW into routine emergency risk stratification for this vulnerable population.