The Metastatic Early Prognostic (MEP) score: a novel scoring tool for predicting early mortality in patients with metastatic proximal femoral fractures

Samantha Downie (Lead / Corresponding author), Florence Y. Lai, Judith Joss, Douglas Adamson, Arpit C. Jariwala

    Research output: Contribution to journalArticle

    Abstract

    Aims: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death.

    Methods: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year.

    Results: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days.

    Conclusion: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.

    Original languageEnglish
    Pages (from-to)72-81
    Number of pages10
    JournalBone and Joint Journal
    Volume102-B
    Issue number1
    Early online date31 Dec 2019
    DOIs
    Publication statusPublished - Jan 2020

    Fingerprint

    Femoral Fractures
    Mortality
    Hip Fractures
    Neoplasm Metastasis
    Thigh
    Trauma Centers
    Orthopedics
    Urea
    Counseling
    Albumins
    Cohort Studies
    Research Design
    Retrospective Studies
    Joints
    Biomarkers
    Calcium
    Bone and Bones
    Control Groups
    Survival

    Keywords

    • Bony lesion
    • Bony metastasis
    • Metastasis
    • Metastatic bony disease
    • Metastatic fracture
    • Pathological fracture
    • Prognosis
    • Severity of Illness Index
    • Time-to-Treatment
    • Humans
    • Middle Aged
    • Male
    • Femoral Neoplasms/mortality
    • Case-Control Studies
    • Scotland/epidemiology
    • Survival Analysis
    • Aged, 80 and over
    • Adult
    • Female
    • Aged
    • Retrospective Studies
    • Biomarkers, Tumor/metabolism

    Cite this

    Downie, Samantha ; Lai, Florence Y. ; Joss, Judith ; Adamson, Douglas ; Jariwala, Arpit C. / The Metastatic Early Prognostic (MEP) score : a novel scoring tool for predicting early mortality in patients with metastatic proximal femoral fractures. In: Bone and Joint Journal. 2020 ; Vol. 102-B, No. 1. pp. 72-81.
    @article{4114dd38da214d5491a114e0f747d070,
    title = "The Metastatic Early Prognostic (MEP) score: a novel scoring tool for predicting early mortality in patients with metastatic proximal femoral fractures",
    abstract = "Aims: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death.Methods: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year.Results: There was a 90-day mortality of 46{\%} in patients with metastatic hip fractures versus 12{\%} in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14{\%}, 3/21), 90 days (19{\%}, 4/21), and one year (62{\%}, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56{\%}, 5/9), 90 days (100{\%}, 9/9), and one year (100{\%}, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days.Conclusion: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.",
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    The Metastatic Early Prognostic (MEP) score : a novel scoring tool for predicting early mortality in patients with metastatic proximal femoral fractures. / Downie, Samantha (Lead / Corresponding author); Lai, Florence Y.; Joss, Judith; Adamson, Douglas; Jariwala, Arpit C.

    In: Bone and Joint Journal, Vol. 102-B, No. 1, 01.2020, p. 72-81.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The Metastatic Early Prognostic (MEP) score

    T2 - a novel scoring tool for predicting early mortality in patients with metastatic proximal femoral fractures

    AU - Downie, Samantha

    AU - Lai, Florence Y.

    AU - Joss, Judith

    AU - Adamson, Douglas

    AU - Jariwala, Arpit C.

    N1 - No funding.

    PY - 2020/1

    Y1 - 2020/1

    N2 - Aims: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death.Methods: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year.Results: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days.Conclusion: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.

    AB - Aims: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death.Methods: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year.Results: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days.Conclusion: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.

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