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 journalArticlepeer-review

    11 Citations (Scopus)


    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
    Issue number1
    Early online date31 Dec 2019
    Publication statusPublished - Jan 2020


    • 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

    ASJC Scopus subject areas

    • Surgery
    • Orthopedics and Sports Medicine


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