Yu Longqing, Liu Fupeng, Zhang Qiuping, Yan Wenhua, Zhang Mei
Department of Clinical Medicine, Jining Medical University, Jining, Shandong, China.
Department of Endocrinology and Metabolism, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
Exp Gerontol. 2025 Jun 1;204:112750. doi: 10.1016/j.exger.2025.112750. Epub 2025 Apr 11.
Sarcopenia index (SI), calculated as serum creatinine/cystatin C × 100, has emerged as a potential marker for muscle loss and adverse outcomes. However, its prognostic value in hip fracture patients remains unclear. This study aimed to investigate the association between SI and all-cause mortality in patients aged 50 and over with hip fracture.
This study included patients aged 50 and over with low-energy hip fractures and followed them for at least two years to track the incidence of death. Collect baseline demographic, clinical and biochemical data. Kaplan-Meier and log-rank analyses were performed to compare the mortality between different SI levels. Univariate and multivariate cox regression models were used to evaluate the relationship between SI and all-cause mortality in patients aged 50 and over with hip fracture. Subgroup analysis was carried out to evaluate the influence of potential regulators, and cubic spline curves were limited to check the potential nonlinear relationship between SI and all-cause mortality.
A total of 637 patients were enrolled in the study, 62 deaths occurred during follow-up. Non-survivors were significantly older (80.02 ± 9.24 vs 71.05 ± 10.75 years, P < 0.001) and had lower SI values (54.06 ± 11.17 vs 61.51 ± 14.51, P < 0.001) compared to survivors. Kaplan-Meier analysis showed significantly better survival in the high SI group (P = 0.0034). In multivariate analysis, SI remained independently associated with mortality after adjusting for comprehensive covariates (HR = 0.98, 95 % CI: 0.95-0.99, P = 0.018). Restricted cubic spline analysis revealed a nearly linear relationship between SI and the risk of death in patients with hip fractures. In subgroup analysis except in diabetes and BMI ≥ 24, SI was negatively correlated with the second hip fracture.
Lower SI values are independently associated with increased all-cause mortality in patients aged 50 and over with hip fracture. SI might serve as a valuable prognostic marker for risk stratification in this population, potentially helping identify high-risk patients who may benefit from more intensive monitoring and intervention.
肌少症指数（SI），计算方法为血清肌酐/胱抑素C×100，已成为肌肉量减少和不良后果的潜在标志物。然而，其在髋部骨折患者中的预后价值仍不明确。本研究旨在调查50岁及以上髋部骨折患者的SI与全因死亡率之间的关联。
本研究纳入50岁及以上的低能量髋部骨折患者，并对他们进行至少两年的随访以追踪死亡发生率。收集基线人口统计学、临床和生化数据。采用Kaplan-Meier法和对数秩检验分析比较不同SI水平之间的死亡率。使用单因素和多因素Cox回归模型评估50岁及以上髋部骨折患者的SI与全因死亡率之间的关系。进行亚组分析以评估潜在调节因素的影响，并绘制限制立方样条曲线以检验SI与全因死亡率之间潜在的非线性关系。
本研究共纳入637例患者，随访期间发生62例死亡。与存活者相比，非存活者年龄显著更大（80.02±9.24岁 vs 71.05±10.75岁，P<0.001）且SI值更低（54.06±11.17 vs 61.51±14.51，P<0.001）。Kaplan-Meier分析显示高SI组的生存率显著更好（P=0.0034）。在多因素分析中，在调整综合协变量后，SI仍与死亡率独立相关（HR=0.98，95%CI：0.95-0.99，P=0.018）。限制立方样条分析显示髋部骨折患者的SI与死亡风险之间存在近乎线性的关系。在亚组分析中，除糖尿病和BMI≥24外，SI与再次髋部骨折呈负相关。
较低的SI值与50岁及以上髋部骨折患者全因死亡率增加独立相关。SI可能是该人群进行风险分层的有价值的预后标志物，有可能帮助识别可能从更密切监测和干预中获益的高危患者。
