Impact of chronic obstructive pulmonary disease on mortality in elderly patients with hip fracture - A retrospective cohort study

Sep 29, 2026

Chronic obstructive pulmonary disease (COPD) is associated with higher mortality in elderly hip-fracture patients, yet its independent prognostic role is uncertain. This retrospective cohort study used propensity score matching to balance confounders between COPD and non-COPD groups, then applied LASSO and Cox regression to identify mortality predictors. Model performance was assessed with ROC, calibration, and decision-curve analyses, including restricted cubic splines and subgroup interactions. Results showed COPD as a strong independent predictor of 1-year mortality.

LanguageEnglish

CategoryResearch & Report

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Pages16

Reading Time40 min

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Abstract

Objective

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Introduction

OPEN ACCESS Citation: Zhu J, Chang Y, Wang X, Li Y, Yang F, Shi Y, et al. (2026) Impact of chronic obstructive pulmonary disease on mortality in elderly patients with hip fracture: A retrospective cohort study. PLoS One 21(1): e0340474. [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0340474 Editor: Ahmet, Çağlar, University of Health Sciences, Beyhekim Training and Research Hospital, TÜRKIYE Received: September 22, 2025 Accepted: December 22, 2025 Published: January 6, 2026 Copyright: © 2026 Zhu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data availability statement: The research results for this study are made available within the paper and its Supporting information files. However, the data used in this study cannot be shared publicly due to restrictions imposed by RESEARCH ARTICLE Impact of chronic obstructive pulmonary disease on mortality in elderly patients with hip fracture: A retrospective cohort study Jiaxuan Zhu☯, Yu Chang☯, Xiaomin Wang, Yuying Li, Fan Yang, Yuwei Shi, Xiuguo Zhang* Department of Nursing, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China ☯ These authors contributed equally to this work. * [37100597@hebmu.edu.cn](37100597@hebmu.edu.cn) Abstract Objective Chronic obstructive pulmonary disease (COPD) is thought to increase mortality risk in elderly patients with hip fracture, but its independent effect remains unclear. This study aimed to determine whether COPD is an independent predictor of mortality in this population. Methods A retrospective cohort study was conducted on elderly patients with hip fractures. Through propensity score matching, confounding factors between patients with chronic obstructive pulmonary disease (COPD) and those without COPD were balanced. LASSO and Cox regression methods were used to identify predictors of mortality. The performance of the model was evaluated via ROC curves, calibration curves, and decision curve analysis. Restrictive cubic spline analysis and subgroup analysis were also performed to assess nonlinear effects and interactions. Results A total of 151 (11 .08%) of the 1362 participants who were enrolled in the trial had COPD. After PSM, 537 data points were analysed. The COPD group presented a significantly greater incidence of postoperative respiratory failure (6 .04%) and delirium (12 .08%) and significantly greater 1-year mortality (22 .82% vs. 5.93%) . COPD was identified as a strong independent predictor of mortality (HR 7.291, 95% CI: 3.619 ~ 14.691) . Other independent risk factors included age (HR 1.066, 95% CI: 1.016 ~ 1. 118), HCT (HR 0 .922, 95% CI: 0.872 ~ 0.975), CAR (HR 1.476, 95% CI: 1.209 ~ 1.801), and BNP (HR 1.001, 95% CI: 1.000 ~ 1.001) . The prediction model PLOS One | [https://doi.org/10.1371/journal.pone.0340474](https://doi.org/10.1371/journal.pone.0340474) January 6, 2026 1 / 16 the Third Hospital of Hebei Medical University. Data are available upon request from the Third Hospital of Hebei Medical University’s data management department via telephone (+86- 0311-8860-3236) or email (ssyhlb2138@sina. com) for researchers who meet the criteria for access to confidential data. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. showed good predictive efficiency, achieving an AUC of 0.834 (95% CI: 0.766, 0.902) in the training set and 0.892 (95% CI: 0.819, 0.965) in the validation set. Restricted cubic splines confirmed linear relationships between continuous predictors and mortality risk (all P values for nonlinearity > 0.05) . Subgroup analysis revealed a significant interaction effect between sex and COPD (p = 0.028) . Conclusi

FAQs

What was the study objective regarding COPD and mortality?

To determine whether COPD is an independent predictor of mortality in elderly patients with hip fracture.

How did the study control confounding between COPD and non-COPD groups?

It used propensity score matching to balance confounding factors between the two groups.

What were the main findings about mortality prediction?

COPD was identified as a strong independent predictor of 1-year mortality, and the developed prediction model showed good predictive efficiency with strong AUC values.

Sep 29, 2026

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