C-反应蛋白与白蛋白比值对老年髋部骨折患者短期预后的影响

Effect of preoperative ratio of C-reactive protein to albumin on prognosis of elderly patients with hip fracture

摘要:

目的 探讨老年髋部骨折患者术前血清C-反应蛋白与白蛋白比值(CRP/Alb)在预测老年髋部骨折患者术后1年内死亡的临床价值。方法 回顾性分析2015年1月至2017年8月,在中国人民解放军中部战区总医院骨科接受手术治疗的老年髋部骨折患者临床资料。根据患者术后1年内是否死亡分为存活组和死亡组。采用多元logistic 回归分析筛选出老年髋部骨折患者术后1年内死亡的独立危险因素；并采用受试者工作特征(ROC)曲线和Kaplan-Meier法分析CRP/Alb对老年髋部骨折患者不良预后的评估价值。结果 共165例患者纳入最终研究,术后1年内累计死亡率为20.61％。单因素分析结果显示,死亡组年龄、红细胞分布宽度、CRP、CRP/Alb、合并慢性肺部疾病比例和ASA分级均明显高于存活组,Alb明显低于存活组,差异均具有统计学意义(P＜0.05)。多因素分析结果显示CRP/Alb(OR=2.472,95％CI 1.100~5.554)是老年髋部骨折患者术后1年内死亡的重要危险因素。CRP/Alb预测老年髋部骨折不良预后的曲线下面积(AUC)为0.949(95％CI 0.915～0.984,P＜0.001),均明显高于CRP或Alb单指标预测。当CRP/Alb取3.05为最佳截断点时,将患者分为CRP/Alb高比值组(n=37)和低比值组(n=128),CRP/Alb高比值组患者生存期明显低于低比值组,差异具有统计学意义(χ²=48.607,P＜0.001)。结论 CRP/Alb是老年髋部骨折患者术后1年内死亡的独立危险因素,CRP/Alb比值可作为预测不良临床结局的有效指标。

Abstract:

Objective To investigate the clinical value of preoperative ratio of C-reactive protein to albumin (CRP/Alb) in predict-ing 1-year mortality after hip fracture in the elderly patients. Methods A retrospective analysis was made of the clinical data of the elderly patients with hip fracture, who underwent orthopedic surgery at the Chinese PLA Central Theater General Hospital from January 2015 to August 2017. According to whether the patient died within 1 year after surgery, the patients were divided into survival group and death group. Multivariate logistic regression was performed to explore independent risk factors for death within 1 year after surgery. The receiver operating charactersitic (ROC) curve and Kaplan-Meier method were used to analyze the value of CRP/Alb in evaluating poor prognosis in the elderly patients with hip fracture. Results A total of 165 patients were enolled in the final study, and the cumulative mortality rate was 20.61% within 1 year after surgery. Univariate analysis showed that the survival group had significantly higher age, red blood cell distribution width, CRP, CRP/Alb, rate of concomitant chronic lung disease and ASA grade but lower Alb than the death group, the difference being of statistical significance (P<0.05). Multivariate analysis showed that CRP/Alb (OR=2.472,95％CI 1.100-5.554) was an important risk factor for predicting death in the elderly patients with hip fracture within 1 year after surgery. AUC of CRP/Alb in predicting the poor prognosis was 0.949 (P<0.001,5%CI 0.915-0.984), which was significantly higher than the single-index prediction of CRP or Alb. When CRP/Alb of 3.05 was set as the optimal cut-off value, the patients were divided into high-ratio group (n=37) and low-ratio group (n=128). The former had significantly shorter survival than the latter, the difference being statistically significant (χ²=48.607, P<0.001). Conclusion CRP/Alb is an independent risk factor for predicting death within 1 year after surgery in the elderly patients with hip fracture and can be used as an effective indicator for predicting adverse clinical outcomes.