CRP/Alb比值对老年髋部骨折患者术后1年内死亡的预测价值分析

The value of CRP/ALB ratio in predicting the death within one year after operation in elderly patients with hip fracture

目的探讨血清C反应蛋白与白蛋白比值(CRP/Alb)对老年髋部骨折患者术后1年内死亡的预测价值。方法回顾性分析2018年6月—2019年6月无锡市人民医院骨科收治的154例老年髋部骨折患者的病例资料,男性103例,女性51例;年龄65~85岁,平均75.8岁;合并0~2种内科疾病106例,2种以上48例。根据患者术后1年内生存情况分为存活组(121例)与死亡组(33例),收集可能影响患者生存的相关影响因素,包括性别、年龄、体质量指数(BMI)、合并疾病、血常规、肝肾功能、手术方式、麻醉方式、手术时长、致伤原因等,同时记录患者入院当天、术后第1天、第3天CRP、Alb以及CRP/Alb的平均值,运用二分类多因素Logistic回归分析。结果术后1年内随访率为100%。其中154例患者死亡33例,病死率为21.43%。单因素结果显示,老年髋部骨折患者术后1年内死亡,与年龄>75岁、合并多种内科疾病、白蛋白(Alb)水平低、C反应蛋白(CRP)水平高、CRP/Alb比值高以及美国麻醉医师协会(ASA)分级III~IV级有关(t=30.256、56.411、4.007、20.644、6.509、16.684,P<0.05);多因素结果显示,Alb水平低、CRP水平高、CRP/Alb比值低是老年髋部骨折患者术后1年内死亡的独立危险因素(OR=1.532、2.114、2.625,P<0.05);CRP/Alb预测老年髋部骨折患者术后预后不良的曲线下面积(area under ROC curve,AUC)均明显高于CRP或Alb单指标预测(P<0.05)。结论老年髋部骨折患者术后1年内死亡与CRP/Alb比值增大有关,是患者术后1年内死亡的相关因素,CRP/Alb比值可作为临床预测患者不良结局的重要指标。

Objective To investigate the predictive value of serum C-reactive protein to albumin ratio(CRP/ALB)in predicting death in the elderly patients with hip fracture within one year after operation.Methods The clinical data of 154 elderly patients with hip fracture treated in our hospital from Jun.2018 to Jun.2019 were retrospectively analyzed.There were 103 males and 51 females.The age range was 65-85 years,with an average age of 75.8 years.There were 106 cases with 0-2 kinds of internal diseases and 48 cases with>2 kinds.According to the survival situation within one year after operation,the patients were divided into survival group and death group.Related influencing factors such as gender,age,BMI,complications,blood routine,liver and kidney function,operation mode,anesthesia mode,operation duration,causes of injury were collected.At the same time,the average value of CRP,Alb and CRP/Alb on the day of admission,the first day and the third day after operation was recorded,and binary multivariate logistic regression analysis was used.Results The follow-up rate within 1 year was 100%.Among the 154 patients,33 patients died,and the mortality rate was 21.43%.Univariate analysis showed that the mortality within one year after operation was related to age>75 years,multiple medical diseases,low Alb level,high CRP level,and high CRP/Alb ratio and ASA grade III-IV(P<0.05).Multivariate analysis showed that low Alb level,high CRP level,and high CRP/Alb ratio were important independent risk factors for death within one year after operation in elderly patients with hip fracture(OR=2.62,P<0.05).The area under ROC curve(AUC)of CRP/Alb was significantly higher than that of CRP or Alb alone(P<0.05).Conclusion The mortality of elderly patients with hip fracture within one year after operation is related to the increase of CRP/Alb ratio,which is the related factor of death within one year after operation.CRP/Alb ratio can be used as an important index to predict the adverse outcome of patients.