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Purpose <p>Patients with femoral head necrosis (FHN) represent a distinct subgroup undergoing total hip arthroplasty (THA), often characterized by younger age, specific etiologies, and potentially higher nutritional risks. This study aimed to develop and validate a nomogram for predicting human serum albumin (HSA) infusion after THA in this FHN population.</p> Patients and methods <p>A retrospective analysis was conducted on 584 patients who underwent primary THA due to femoral head necrosis at Jiangsu Provincial Subei People’s Hospital from January 2018 to April 2022. Univariate and multivariable logistic regression analyses, along with LASSO regression, were employed to determine independent risk factors. A predictive model incorporating nomogram was constructed and its performance evaluated using ROC curves, calibration curves, and decision curve analyses.</p> Results <p>Among the 584 enrolled patients, 107 (18.3%) received human serum albumin infusion postoperatively.&#xa0;This cohort was then randomly split into a modeling set (<i>n</i> = 409) for model development and a validation set (<i>n</i> = 175) for internal validation. Seven independent risk factors were identified: age, BMI, surgical duration, preoperative PTINR, preoperative RBC count, preoperative HCT, and preoperative serum albumin levels. The model demonstrated high accuracy with an AUC of 0.854 (95% CI 0.804–0.903) in the modeling group and 0.790 (95% CI 0.700–0.881) in the validation group. Calibration curves indicated good agreement between predicted and observed outcomes.</p> Conclusion <p>The proposed nomogram, based on seven independent risk factors, effectively predicts the risk of post-THA hypoalbuminemia requiring albumin infusion in patients with femoral head necrosis.&#xa0;Utilizing this tool to mitigate hypoalbuminemia is potentially clinically significant for lowering healthcare costs, minimizing transfusion-related complications, and facilitating enhanced recovery.</p>

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Risk factors and predictive nomogram of human serum albumin infusion after total hip arthroplasty for femoral head necrosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月27日

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  • Haixiang Miao,
  • Han Gong,
  • Weishi Hong,
  • Zhiwei Peng,
  • Jihang Dai

摘要

Purpose

Patients with femoral head necrosis (FHN) represent a distinct subgroup undergoing total hip arthroplasty (THA), often characterized by younger age, specific etiologies, and potentially higher nutritional risks. This study aimed to develop and validate a nomogram for predicting human serum albumin (HSA) infusion after THA in this FHN population.

Patients and methods

A retrospective analysis was conducted on 584 patients who underwent primary THA due to femoral head necrosis at Jiangsu Provincial Subei People’s Hospital from January 2018 to April 2022. Univariate and multivariable logistic regression analyses, along with LASSO regression, were employed to determine independent risk factors. A predictive model incorporating nomogram was constructed and its performance evaluated using ROC curves, calibration curves, and decision curve analyses.

Results

Among the 584 enrolled patients, 107 (18.3%) received human serum albumin infusion postoperatively. This cohort was then randomly split into a modeling set (n = 409) for model development and a validation set (n = 175) for internal validation. Seven independent risk factors were identified: age, BMI, surgical duration, preoperative PTINR, preoperative RBC count, preoperative HCT, and preoperative serum albumin levels. The model demonstrated high accuracy with an AUC of 0.854 (95% CI 0.804–0.903) in the modeling group and 0.790 (95% CI 0.700–0.881) in the validation group. Calibration curves indicated good agreement between predicted and observed outcomes.

Conclusion

The proposed nomogram, based on seven independent risk factors, effectively predicts the risk of post-THA hypoalbuminemia requiring albumin infusion in patients with femoral head necrosis. Utilizing this tool to mitigate hypoalbuminemia is potentially clinically significant for lowering healthcare costs, minimizing transfusion-related complications, and facilitating enhanced recovery.