老年髋部骨折关节置换或内固定术前C-反应蛋白与白蛋白比值评价短期预后的可能性

Feasibility of preoperative ratio of C-reactive protein to albumin for assessing the prognosis of older adults with hip fracture undergoing arthroplasty or internal fixation

背景:既往国内外文献报道术前血清C-反应蛋白和白蛋白水平均可用于预测老年髋部骨折患者术后1 年内死亡率,但尚未有文献报道两者联合评估的临床价值。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(C-reactive protein/albumin,CRP/Alb)对预后的影响。方法:老年髋部骨折患者155 例进行内固定或关节置换治疗。检测患者术前血清C-反应蛋白与白蛋白水平,并计算CRP/Alb。根据中位值2.37,将患者分为CRP/Alb 高比值组和低比值组。分析CRP/Alb 与临床资料关系,采取Kaplan-Meier 法进行生存分析,及Cox 风险模型分析老年髋部骨折预后的影响因素。结果与结论:①CRP/Alb 高比值组患者年龄更大,C-反应蛋白水平更高、合并慢性肺部疾病和ASA Ⅲ级/Ⅳ级比例更多,白蛋白水平较低(P < 0.05);②CRP/Alb 高比值组术后1 年内死亡率(20.65%)明显高于低比值组患者(11.84%)(χ^2=7.053,P=0.008);③年龄、美国麻醉医师协会(ASA)分级及CRP/Alb 比值是老年髋部骨折患者预后的独立危险因素;④结果说明,老年髋部骨折患者术前CRP/Alb 比值对预测术后1 年内生存率具有一定价值,术前CRP/Alb 高比值患者提示预后较差。

BACKGROUND: Preliminary studies have shown that preoperative serum levels of C-reactive protein and albumin can predict the mortality in elderly patients with hip fracture within 1 year after surgery, but there has not been a report on the clinical value of combined evaluation.OBJECTIVE: To investigate the effect of preoperative ratio of serum C-reactive protein to albumin on prognosis of elderly patients with hip fracture. METHODS: The serum levels of C-reactive protein and albumin in 155 patients with hip fractures undergoing internal fixation or arthroplasty were detected, and the ratio of C-reactive protein/albumin was measured. According to the median value of 2.37, patients were divided into high ratio group and low ratio group. The relationship between C-reactive protein/albumin and clinical data was analyzed. The Kaplan-Meier method was used for survival analysis. The Cox risk model was used to analyze the prognostic factors of hip fracture in elderly patients. RESULTS AND CONCLUSION:(1) Patients in the high ratio group were older, had higher C-reactive protein level, more chronic lung disease and American Society of Anesthesiologists grade III/IV ratio, and lower albumin level compared with the low ratio group (P < 0.05).(2) The mortality rate (20.65%) in the high ratio group was significantly higher than that in the low ratio group (11.84%)(χ^2=7.053, P=0.008).(3) Age, American Society of Anesthesiologists classification and C-reactive protein/albumin ratio were independent risk factors for elderly patients with hip fracture.(4) In summary, the preoperative C-reactive protein/albumin ratio in elderly patients with hip fracture has a certain value in predicting the survival rate within 1 year after operation. High preoperative C-reactive protein/albumin ratio suggests poor prognosis.