Wu Rongjie, Ma Yuanchen, Chen Duanyong, Li Mengyuan, Li Zeng, Deng Zhantao, Zheng Qiujian, Fu Guangtao
Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China; Shantou University Medical College, Shantou, Guangdong Province, PR China.
Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China.
Bone. 2023 Dec;177:116922. doi: 10.1016/j.bone.2023.116922. Epub 2023 Sep 27.
To investigate the utility of serum C-terminal cross-linking telopeptides (β-CTX) and procollagen type I N propeptide (PINP) for predicting one-year mortality and walking ability in Chinese geriatric hip fracture patients who underwent surgical interventions.
Elderly patients (≥ 60 years) who underwent surgical interventions for unilateral low-energy hip fracture from 2015 to 2020 in our center were included. Demographic data was retrospectively retrieved from the electronic medical database. The PINP and β-CTX concentrations were measured before the surgery. The patients were divided into two groups according to the outcome of mortality and walking ability after hip surgery, respectively. β-CTX and PINP were divided into four grades based on quartiles [Quartile(Q)1-4] for further analysis. All the variables with p < 0.1 in univariable analysis were included in a multivariable model.
In univariable analysis, the levels of serum β-CTX (p = 0.007) and PINP (p = 0.025) was associated with one-year mortality, while the association between levels of serum β-CTX (p = 0.072) or PINP (p = 0.055) with one-year disability was marginally significant. After adjustment for confounders, the relative risk [OR (95 % CI), Q4 v sQ1, p-value] of one-year mortality and one-year disability were 7.28 (2.08-29.78, p = 0.003) and 3.97 (1.44-11.69, p = 0.009) for β-CTX and 5.87 (1.70-23.80, p = 0.008) and 3.48 (1.30-9.93, p = 0.016) for PINP, respectively. The coefficient of determination, AUC and bias-corrected C-index of predictive models based on previously reported predictors were significantly improved after integrating β-CTX or PINP.
Higher serum β-CTX and PINP are independently associated with an increased risk of one-year mortality and disability in patients with hip fractures. The application of BTMs improves the performance of currently available predictive models.
探讨血清C端交联羧基末端肽（β-CTX）和I型前胶原氨基端前肽（PINP）对预测接受手术干预的中国老年髋部骨折患者一年死亡率和行走能力的效用。
纳入2015年至2020年在本中心接受单侧低能量髋部骨折手术干预的老年患者（≥60岁）。从电子医疗数据库中回顾性检索人口统计学数据。在手术前测量PINP和β-CTX浓度。根据髋部手术后的死亡率和行走能力结果，将患者分别分为两组。β-CTX和PINP根据四分位数[四分位数（Q）1-4]分为四个等级进行进一步分析。单变量分析中p<0.1的所有变量都纳入多变量模型。
在单变量分析中，血清β-CTX（p=0.007）和PINP（p=0.025）水平与一年死亡率相关，而血清β-CTX（p=0.072）或PINP（p=0.055）水平与一年残疾之间的关联具有边缘显著性。在对混杂因素进行调整后，β-CTX的一年死亡率和一年残疾的相对风险[OR（95%CI），Q4 vs Q1，p值]分别为7.28（2.08-29.78，p=0.003）和3.97（1.44-11.69，p=0.009），PINP分别为5.87（1.70-23.80，p=0.008）和3.48（1.30-9.93，p=0.016）。在整合β-CTX或PINP后，基于先前报道的预测指标的预测模型的决定系数、AUC和偏差校正C指数显著提高。
较高的血清β-CTX和PINP与髋部骨折患者一年死亡率和残疾风险增加独立相关。骨转换标志物的应用改善了现有预测模型的性能。
