Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.
J Cachexia Sarcopenia Muscle. 2021 Dec;12(6):2238-2246. doi: 10.1002/jcsm.12845. Epub 2021 Oct 27.
The aim of this study was to evaluate prognostic value of body tissue composition at the upper thigh level for 1 year mortality in elderly patients with proximal femur fracture.
This retrospective cohort study included consecutive elderly (aged ≥65) patients diagnosed with proximal femur fracture based on the findings of pelvic bone computed tomography (CT) performed at the emergency department of a tertiary care hospital and treated with surgery between 2010 and 2017. The cross-sectional area of subcutaneous fat and skeletal muscle at the upper thigh level was measured using CT. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 1 year mortality were estimated using a Cox proportional hazards model. Survival based on the SFA quartiles was assessed using nonparametric Kaplan-Meier survival analysis and compared used log-rank tests.
Among 876 elderly patients included in this study, the median age was 79.0 years, and 646 (73.7%) patients were female. A total of 93 (10.6%) died within 1 year after admission to the emergency department. Survivors had a significantly higher median subcutaneous fat area (SFA) than non-survivors (170.2 vs. 133.0 cm , P < 0.001), but no significant difference was observed between the skeletal muscle area (median, 156.7 vs. 160.3 cm , P = 0.504) and muscle density (median, 19.0 vs. 19.1 HU, P = 0.861) of both groups. After adjustment of other clinical characteristics and body compositions, the multivariate Cox proportional hazard analysis showed that SFA (adjusted HR, 0.987; 95% CI, 0.982-0.992; P < 0.001) was independently associated with 1 year mortality. With 384 deaths during 51 322 person-months of follow-up, the median estimated survival duration of all the patients was 92.8 months (95% CI, 80.8-104.7 months). The patients with SFA in the third (165.6-195.0 cm ) and fourth (>195.0 cm ) quartiles showed significantly longer survival duration than those with SFA in the first (<131.4 cm ; median survival time, 51.3 months) and second (131.4-165.5 cm ; median survival time, 88.7 months) quartiles (P < 0.001 by log-rank test).
The SFAs measured at the upper thigh level and 1 year mortality are positively associated in elderly patients with proximal femur fracture. SFA may be an independent prognostic biomarker for 1 year mortality of femur fracture.
本研究旨在评估大腿上部组织成分对老年股骨近端骨折患者 1 年死亡率的预后价值。
本回顾性队列研究纳入了 2010 年至 2017 年期间因骨盆骨 CT 检查在三级医院急诊科诊断为股骨近端骨折并接受手术治疗的连续老年（年龄≥65 岁）患者。使用 CT 测量大腿上部的皮下脂肪和骨骼肌的横截面积。使用 Cox 比例风险模型估计 1 年死亡率的调整后风险比（HR）和 95%置信区间（CI）。使用非参数 Kaplan-Meier 生存分析评估基于 SFA 四分位数的生存情况，并使用对数秩检验进行比较。
在这项研究中，共有 876 名老年患者被纳入，中位年龄为 79.0 岁，646 名（73.7%）为女性。共有 93 名（10.6%）患者在急诊科入院后 1 年内死亡。幸存者的平均皮下脂肪面积（SFA）显著高于非幸存者（170.2 比 133.0 cm ，P <0.001），但两组的骨骼肌面积（中位数，156.7 比 160.3 cm ，P=0.504）和肌肉密度（中位数，19.0 比 19.1 HU，P=0.861）无显著差异。在调整其他临床特征和身体成分后，多变量 Cox 比例风险分析显示 SFA（调整 HR，0.987；95%CI，0.982-0.992；P <0.001）与 1 年死亡率独立相关。在 51322 人月的随访期间有 384 人死亡，所有患者的中位估计生存时间为 92.8 个月（95%CI，80.8-104.7 个月）。SFA 处于第三（165.6-195.0 cm ）和第四（>195.0 cm ）四分位区间的患者的生存时间明显长于 SFA 处于第一（<131.4 cm ；中位生存时间，51.3 个月）和第二（131.4-165.5 cm ；中位生存时间，88.7 个月）四分位区间的患者（对数秩检验 P<0.001）。
股骨近端骨折老年患者大腿上部的 SFA 与 1 年死亡率呈正相关。SFA 可能是股骨骨折 1 年死亡率的独立预后生物标志物。
