Association between the updated Charlson comorbidity index and 1-year mortality after fragility fracture of the pelvis: A prospective observational study.

Background

Fragility fracture of the pelvis is associated with substantial mortality in older adults. However, simple clinical indicators associated with 1-year mortality remain limited. The updated Charlson Comorbidity Index was developed by reweighting comorbidities to reflect advances in contemporary medical care and changes in their associations with mortality.

Methods

This prospective, single-center observational study included 46 patients aged 65 years or older with fragility fracture of the pelvis. Baseline clinical, laboratory, and functional data were collected at admission. Univariable logistic regression and Firth logistic regression analyses were performed to identify factors associated with 1-year mortality. Kaplan-Meier survival and receiver-operating characteristic curve analyses were also performed as exploratory analyses.

Results

During the 1-year study period, there were no in-hospital deaths and 9 post-discharge deaths (19.6%). Univariable analysis identified significant associations of age, the updated Charlson Comorbidity Index score, and serum albumin level with mortality. Firth logistic regression analysis showed that age (adjusted odds ratio 1.19, 95% confidence interval 1.03-1.47; p = 0.010) and the updated Charlson Comorbidity Index score (adjusted odds ratio 2.55, 95% confidence interval 1.43-7.21; p < 0.001) were independently associated with 1-year mortality. In the exploratory Kaplan-Meier analysis using a post hoc cutoff of ≥2, survival was significantly less likely in patients with an updated Charlson Comorbidity Index score of ≥2 than in those with a score of 0-1 (p = 0.002, log-rank test). Receiver-operating characteristic curve analysis showed an apparently high area under the curve in this exploratory cohort.

Conclusion

In this small prospective cohort, a higher updated CCI score was associated with increased 1-year mortality after FFP. These exploratory findings require validation in larger multicenter cohorts.