老年髋部骨折患者急性脑梗死的危险因素分析及预测模型构建OA

Objective To identify independent risk factors for acute cerebral infarction(ACI)in elderly patients with hip fracture and to develop a clinically applicable nomogram for individualized risk prediction.Methods This retrospective study included 603 elderly patients with hip fracture admitted to the Third Depart-ment of Traumatic Hip Surgery,Tianjin Hospital,China,between January 2023 and June 2025.Patients were randomly allocated to a training cohort(n=400)and a validation cohort(n=203)and categorized based on the occurrence of ACI.Clinical and laboratory variables were collected.Univariate and multivariable logistic regression analyses were performed to identify independent predictors of ACI.A nomogram was constructed using R software based on these predictors,and its performance was evaluated in terms of discrimination,calibration,and clinical utility.Results In the training cohort,27 of 400 patients(6.75%)developed ACI.Multivariable logistic regression identified seven independent predictors:prior cerebral infarction,lower lymphocyte count,lower albumin level,elevated serum homocysteine,higher cystatin C,elevated glycated hemoglobin(HbA1c),and prolonged prothrom-bin time(all P<0.05).The nomogram based on these factors demonstrated excellent discrimination,with an area under the ROC curve(AUC)of 0.896(95%CI:0.843-0.949)in the training cohort and 0.830(95%CI:0.737-0.923)in the validation cohort.Calibration plots showed good agreement between predicted and observed probabilities of ACI.Decision curve analysis confirmed the model's favorable clinical net benefit across a range of threshold probabilities.Conclusions Prior cerebral infarction,lymphopenia,hypoalbuminemia,hyperhomocys-teinemia,elevated cystatin C,higher HbA1c,and prolonged prothrombin time are independent predictors of ACI in elderly hip fracture patients.The developed nomogram exhibits robust discrimination,calibration,and clinical utility,offering a practical tool to facilitate early identification and targeted prevention of ACI in this high-risk population.