High mortality after pelvis and lower limb fractures in ESRD
Notice bibliographique
Résumé
Sir, The high mortality rate associated with hip fracture in the general population, as well as in the end-stage renal disease (ESRD) population, is well described. However, the mortality associated with pelvis and lower limb fractures in ESRD patients remains unknown. We reviewed the medical records of all chronic haemodialysis or peritoneal dialysis patients hospitalized at Maisonneuve-Rosemont Hospital for a fracture from 1 July 1995 to 1 February 2007. Femoral neck, pelvis, femoral condyle, tibial plateau, patella, tibia and malleolus fractures were considered. Femoral neck and pelvis fractures were analysed separately, while the other fractures were analysed together as lower limb fractures. All patients who died during the study period were identified and mortality rates were calculated. During the 127-month-long study period, 60 dialysis patients were hospitalized for a total of 68 fractures. Seven patients had two fracture episodes, and one patient had three fracture episodes. The three most common fracture sites were hip (40 cases), pelvis (13 cases) and malleolus (8 cases) (Table 1). The 1-year mortality rate after a hip fracture was 42.5% (17 patients), with an in-hospital mortality rate of 20%. Two patients died during their hospitalization for a pelvis or lower limb fracture. One-year mortality rates were 30.8% after a pelvis fracture and 20% after a lower limb fracture. Median survival during the observation period was 427 days after a pelvis fracture and 581 days after a lower limb fracture. One-year mortality by fracture type Hip fracture is associated with a 1-year mortality rate of 24% in the general population [1]. In ESRD, the 1-year mortality rate after a hip fracture approximates 50% [2]. Our results are consistent with previously reported mortality rates. Few studies have described the mortality associated with pelvis or lower limb fractures in the general population. In a British study, the 1-year mortality rates were 8.7% after pelvis fracture and 2.4% after a lower limb fracture [3]. In our ESRD cohort, the 1-year mortality rates for pelvis and lower limb fractures were increased 3.5- and 8.3-fold, respectively. In fact, the impact of pelvis and lower limb fractures on mortality in ESRD patients appears very similar to the impact of hip fracture in the general population. Like hip fractures [4,5], pelvis and lower limb fractures are probably markers of poor nutritional and general health status in this population. With a 1-year mortality rate similar to that of hip fracture in the general population, our data delineate for the first time the poor outcomes associated with pelvis and lower limb fractures in ESRD patients. The incidence, risk factors, clinical and functional outcomes of such fractures in ESRD patients need to be evaluated in larger, registry-based studies. Conflict of interest statement. None declared.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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