老年髋部骨折患者术前C反应蛋白与白蛋白比值与死亡率的关系：一项横断面研究
[Association of preoperative C-reactive protein to albumin ratio and mortality in elderly patients with hip fractures: A cross-sectional study].
作者信息
Kaya Onur, Efendioglu Eyyup Murat
机构信息
Department of Orthopaedic and Traumatology, Gaziantep City Hospital, Gaziantep-Türkiye.
Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep City Hospital,Gaziantep-Türkiye.
出版信息
Ulus Travma Acil Cerrahi Derg. 2024 Jan;30(12):907-913. doi: 10.14744/tjtes.2024.21433.
BACKGROUND
: Hip fractures in the elderly have a significant impact, both in terms of human suffering and healthcare costs. Little is known about preoperative markers that may predict mortality following geriatric hip fracture surgery. This study aimed to investigate potential risk factors, including the C-reactive protein to albumin ratio (CAR), for mortality in elderly patients undergoing surgery for hip fracture.
METHODS
: A total of 180 elderly patients with hip fractures were included in this cross-sectional study. The patients were divided into two groups: the survival group and the deceased group. Serum levels of C-reactive protein (CRP) and albumin, as well as the CAR, were compared between the two groups to determine whether CAR is a predictor of mortality in elderly patients undergoing hip fracture surgery. The Mini Nutritional Assessment-Short Form was used to evaluate the nutrition status of the patients.
RESULTS
: The mean age of the 180 participants was 78 years, and 53.3% were female. A statistically significant difference was observed between the two groups in terms of the duration of hospital and intensive care unit stay (p<0.05). According to the receiver operating characteristic (ROC) analysis, with a cutoff value of >0.15, CAR could predict mortality after geriatric hip fracture surgery with a sensitivity of 74% and a specificity of 53%. The area under the ROC curve (AUC) for CAR was 0.67 (95% confidence interval [CI]: 0.57-0.76, p<0.001). CAR and the time between fracture and surgery were found to be independent predictors of mortality (p=0.003, odds ratio [OR]=1.37 and p=0.044, OR=1.33, respectively).
CONCLUSION
: An elevated preoperative CAR is associated with a significantly increased risk of mortality in elderly patients undergoing hip fracture surgery. Additionally, a shorter time to surgery was associated with lower mortality in these patients.
背景
老年髋部骨折在人类痛苦和医疗费用方面都有重大影响。关于可能预测老年髋部骨折手术后死亡率的术前标志物知之甚少。本研究旨在调查老年髋部骨折手术患者死亡的潜在风险因素，包括C反应蛋白与白蛋白比值（CAR）。
方法
本横断面研究共纳入180例老年髋部骨折患者。患者分为两组：存活组和死亡组。比较两组患者的血清C反应蛋白（CRP）、白蛋白水平以及CAR，以确定CAR是否为老年髋部骨折手术患者死亡的预测指标。采用微型营养评定简表评估患者的营养状况。
结果
180名参与者的平均年龄为78岁，53.3%为女性。两组在住院时间和重症监护病房停留时间方面存在统计学显著差异（p<0.05）。根据受试者工作特征（ROC）分析，CAR的临界值>0.15时，可预测老年髋部骨折手术后的死亡率，灵敏度为74%，特异度为53%。CAR的ROC曲线下面积（AUC）为0.67（95%置信区间[CI]：0.57 - 0.76，p<0.001）。发现CAR和骨折至手术的时间是死亡的独立预测因素（分别为p = 0.003，比值比[OR]=1.37和p = 0.044，OR = 1.33）。
结论
术前CAR升高与老年髋部骨折手术患者死亡风险显著增加相关。此外，手术时间较短与这些患者的较低死亡率相关。
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