Su Ming, Zhou Peng, Xu Min-Zhe, Gong Ya-Qin, Jin Jian, Hu Wen-Bin, Lu Ke, Li Chong, Yin Yi
Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China.
Kunshan Biomedical Big Data Innovation Application Laboratory, Suzhou, Jiangsu, China.
Front Med (Lausanne). 2025 Aug 14;12:1550525. doi: 10.3389/fmed.2025.1550525. eCollection 2025.
Creatinine clearance (CCR) is a vital biomarker for evaluating renal function, indicating the efficiency of the kidneys in filtering blood waste. However, the link between CCR and mortality in hospitalized patients with osteoporotic fractures (OPFs) remains unclear. The increasing prevalence of OPFs in elderly populations, coupled with known complications of renal dysfunction, underscores the critical importance of understanding this relationship. This study aimed to investigate the association between CCR levels and mortality in a cohort of hospitalized patients with OPFs, with the goal of establishing evidence-based guidelines for risk stratification and management strategies.
A retrospective cohort study analyzed data from 3,177 patients hospitalized with OPFs between 6 December 2018 and 31 December 2023. A multivariate Cox regression analysis was used to evaluate the relationship between CCR and mortality while adjusting for potential confounding variables, including laboratory parameters, clinical characteristics, and lifestyle factors. Subgroup analyses, smoothed curve fitting with threshold analyses, Kaplan-Meier curves, and sensitivity analyses were performed.
A linear correlation between CCR and mortality was observed, with each 1-point increment in CCR correlating with a 2% reduction in mortality risk (hazard ratio (HR) = 0.98; 95% confidence interval (CI): 0.97, 0.98; < 0.01). Patients were categorized into three groups based on CCR: Group 1 (CCR ≤ 80 mL/min), Group 2 (80 < CCR ≤ 120 mL/min), and Group 3 (CCR > 120 mL/min). Group 2 exhibited a 51% lower hazard of mortality than Group 1 (HR = 0.49, 95% CI: 0.34, 0.71; < 0.01), while Group 3 showed an 87% reduction in mortality risk (HR = 0.13, 95% CI: 0.05, 0.36; < 0.01). Subgroup analyses confirmed the robustness of these findings even after adjusting for other covariates. Linear association was detected using smoothed curve fitting and threshold analysis. The Kaplan-Meier survival curves revealed a negative relationship between CCR levels and the cumulative mortality hazard. Sensitivity analyses demonstrated a stable direct association between CCR and the cumulative mortality hazard.
This study demonstrated a significant association between CCR and mortality among hospitalized patients with OPFs, validating CCR as a valuable prognostic marker for assessing mortality risk.
肌酐清除率（CCR）是评估肾功能的重要生物标志物，可反映肾脏过滤血液废物的效率。然而，CCR与骨质疏松性骨折（OPF）住院患者死亡率之间的关系仍不明确。老年人群中OPF的患病率不断上升，再加上已知的肾功能不全并发症，凸显了理解这种关系的至关重要性。本研究旨在调查一组OPF住院患者中CCR水平与死亡率之间的关联，目标是制定基于证据的风险分层和管理策略指南。
一项回顾性队列研究分析了2018年12月6日至2023年12月31日期间3177例因OPF住院患者的数据。采用多变量Cox回归分析评估CCR与死亡率之间的关系，同时对潜在的混杂变量进行调整，包括实验室参数、临床特征和生活方式因素。进行了亚组分析、带阈值分析的平滑曲线拟合、Kaplan-Meier曲线分析和敏感性分析。
观察到CCR与死亡率之间呈线性相关，CCR每增加１个单位，死亡风险降低2%（风险比（HR）=0.98；95%置信区间（CI）：0.97，0.98；P<0.01）。根据CCR将患者分为三组：第1组（CCR≤80 mL/min）、第2组（80<CCR≤120 mL/min）和第3组（CCR>120 mL/min）。第2组的死亡风险比第1组低51%（HR=0.49，95%CI：0.34，0.71；P<0.01），而第3组的死亡风险降低了87%（HR=0.13，95%CI：0.05，0.36；P<0.01）。亚组分析证实，即使在调整其他协变量后，这些发现仍然稳健。通过平滑曲线拟合和阈值分析检测到线性关联。Kaplan-Meier生存曲线显示CCR水平与累积死亡风险之间呈负相关。敏感性分析表明CCR与累积死亡风险之间存在稳定的直接关联。
本研究表明CCR与OPF住院患者的死亡率之间存在显著关联，验证了CCR作为评估死亡风险的有价值预后标志物。
