Lu Wenbin, Rao Miaomiao, Jia Fan, Chen Wubin, Li Bin, Bian Jinjun, Wang Jiafeng
Faculty of Anesthesiology, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People's Republic of China.
Int J Gen Med. 2025 Jul 30;18:4147-4156. doi: 10.2147/IJGM.S531669. eCollection 2025.
This study aimed to investigate the association between the serum creatinine-to-cystatin C ratio (CCR) and the prognosis of patients with hip fracture.
This retrospective cohort study included patients who underwent hip fracture surgery at a tertiary hospital in China between January 2018 and December 2023. CCR was calculated from the preoperative serum creatinine and cystatin C levels. The primary outcome was 1-year mortality after surgery in patients with hip fracture and the secondary outcome was 6-month mortality. The associations between preoperative CCR and prognosis of patients were assessed using Kaplan-Meier curves, Cox regression models, interactions, and stratified analyses.
A total of 1914 patients who underwent surgery for hip fracture were included. The mean age of the participants was 73.4 ± 14.0 years and the median CCR was 7.3 (6.3-8.5). The prevalence of 1-year mortality flowing hip fracture surgery was 7.3%. Multivariate Cox regression analysis indicated that a high CCR was independently associated with reduced 6-month mortality [hazard ratio (HR) = 0.51; 95% confidence interval (CI) = 0.31-0.84] and 1-year mortality (HR = 0.61; 95% CI = 0.42-0.90) after adjusting for covariates. In addition, Kaplan-Meier curve analyses indicated that the low CCR group had higher 6-month and 1-year mortality rates (all <0.0001). Subgroup analyses showed that a high CCR was independently associated with reduced 1-year mortality after hip surgery in patients with diabetes (HR = 0.39; 95% CI = 0.17-0.89), males (HR = 0.48; 95% CI = 0.26-0.86) and those without hypertension (HR = 0.55; 95% CI = 0.32-0.97) or cardiovascular disease (HR = 0.54; 95% CI = 0.34-0.84).
Our study found that a low CCR was associated with poor prognosis in patients undergoing hip fracture surgery. Further research is needed to clarify the mechanism linking low CCR to poor prognosis in hip fracture patients.
本研究旨在探讨血清肌酐与胱抑素C比值（CCR）与髋部骨折患者预后之间的关联。
这项回顾性队列研究纳入了2018年1月至2023年12月在中国一家三级医院接受髋部骨折手术的患者。CCR根据术前血清肌酐和胱抑素C水平计算得出。主要结局是髋部骨折患者术后1年死亡率，次要结局是6个月死亡率。采用Kaplan-Meier曲线、Cox回归模型、交互作用分析和分层分析评估术前CCR与患者预后之间的关联。
共纳入1914例接受髋部骨折手术的患者。参与者的平均年龄为73.4±14.0岁，CCR中位数为7.3（6.3 - 8.5）。髋部骨折手术后1年死亡率为7.3%。多因素Cox回归分析表明，在校正协变量后，高CCR与降低6个月死亡率[风险比（HR）= 0.51；95%置信区间（CI）= 0.31 - 0.84]和1年死亡率（HR = 0.61；95% CI = 0.42 - 0.90）独立相关。此外，Kaplan-Meier曲线分析表明，低CCR组的6个月和1年死亡率更高（均<0.0001）。亚组分析显示，高CCR与糖尿病患者（HR = 0.39；95% CI = 0.17 - 0.89）、男性（HR = 0.48；95% CI = 0.26 - 0.86）以及无高血压（HR = 0.55；95% CI = 从0.32至0.97）或心血管疾病（HR = 0.54；95% CI = 0.34 - 0.84）的患者髋部手术后1年死亡率降低独立相关。
我们的研究发现，低CCR与髋部骨折手术患者的不良预后相关。需要进一步研究以阐明低CCR与髋部骨折患者不良预后之间的关联机制。
