Association of preoperative C-reactive protein to albumin ratio and mortality in elderly patients with hip fractures: A cross-sectional study

Kaya, Onur; Efendioglu, Eyyup Murat

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Association of preoperative C-reactive protein to albumin ratio and mortality in elderly patients with hip fractures: A cross-sectional study [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2024; 30(12): 907-913 | DOI: 10.14744/tjtes.2024.21433

Association of preoperative C-reactive protein to albumin ratio and mortality in elderly patients with hip fractures: A cross-sectional study

Onur Kaya¹, Eyyup Murat Efendioglu²
¹Department of Orthopaedic and Traumatology, Gaziantep City Hospital, Gaziantep-Türkiye
²Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep City Hospital,Gaziantep-Türkiye

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.

Keywords: C-reactive protein (CRP) to albumin ratio, elderly patients, hip fracture, Mini Nutritional Assessment-Short Form, mortality.

Geriatrik kal�a k�r�klar�nda preoperatif C-reaktif protein-albümin oran�n�n mortaliteyle ili�kisi: Kesitsel �al��ma

Onur Kaya¹, Eyyup Murat Efendioglu²
¹Gaziantep �ehir Hastanesi, Ortopedi ve Travmatoloji Klini�i, Gaziantep, Türkiye
²Gaziantep �ehir Hastanesi, �� Hastal�klar� Geriatri Klini�i, Gaziantep, Türkiye

AMA�: Geriatrik d�nem kal�a k�r�klar�n�n hem hasta a��s�ndan hem de maliyet üzerine etkisi büyüktür. Geriatrik kal�a k�r�� cerrahisi sonras� mortaliteyi �ng�rebilecek preoperatif belirte�ler hakk�nda az bilgi mevcuttur. Bu �al��ma, kal�a k�r�� i�in cerrahi ge�iren ya�l� hastalarda mortalite i�in C-reaktif protein/albümin oran� (CAR) dahil olmak üzere potansiyel risk fakt�rlerini ara�t�rmay� ama�lam��t�r.
GERE� VE Y�NTEM: Bu kesitsel �al��maya 180 ya�l� kal�a k�r�� hastas� dahil edildi. Hastalar, hayatta kalanlar ve �lenler olmak üzere iki gruba ayr�ld�. Serum CRP ve albümin düzeyleri, CAR ile birlikte, bu iki grup aras�nda CAR'�n ya�l� yeti�kinlerde kal�a k�r�� ameliyat� ge�iren hastalarda mortaliteyi �ng�rüp �ng�remeyece�ini belirlemek i�in kar��la�t�r�ld�. Hastalar�n beslenme durumunu de�erlendirmek i�in Mini Beslenme De�erlendirme-K�sa Formu kullan�ld�.
BULGULAR: 180 kat�l�mc�n�n ortalama ya�� 78 idi ve %53.3'ü kad�nd�. Hastane ve yo�un bak�m ünitesinde kal�� süresi a��s�ndan bu iki grup aras�nda istatistiksel olarak anlaml� fark bulundu (p<0.05). Al�c� i�letim karakteristi�i (ROC) analizine g�re, CAR (C-reaktif protein/albumin oran�) i�in kestirim de�eri >0.15 olarak belirlendi�inde, CAR, geriatrik kal�a k�r�� ameliyat� sonras� mortaliteyi %74 duyarl�l�k ve %53 �zgüllük ile �ng�rdü�ü g�rüldü. CAR'�n ROC e�risi alt�nda kalan alan (AUC) de�eri 0.67 idi (95% CI: 0.57-0.76, p<0.001). CAR ve k�r�k ile cerrahi aras�ndaki zaman�n
mortalite i�in ba��ms�z bir de�i�ken oldu�u bulundu (s�ras�yla, p=0.003, OR=1.37 ve p=0.044, OR=1.33).
SONU�: Ameliyat �ncesi d�nemde bak�lan CAR düzeyi yüksek olan ve kal�a k�r�� nedeniyle operasyon ge�iren ya�l� hastalarda �lüm riskinde anlaml� bir art�� oldu�u g�rüldü. Ayr�ca, k�r�ktan cerrahiye kadar ge�en sürenin k�sa olmas� bu hastalarda daha dü�ük mortalite ile ili�kili olarak bulundu.

Anahtar Kelimeler: CRP/albumin oran�, kal�a k�r��, mini beslenme de�erlendirme-k�sa form, mortalite, ya�l� yeti�kinler

Corresponding Author: Onur Kaya, T�rkiye
Manuscript Language: Turkish

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