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. 2023 Jul 7;12(13):4544.
doi: 10.3390/jcm12134544.

Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study

Giorgio Cacciola  1 , Fabio Mancino  2 , Lukas A Holzer  2 , Federico De Meo  1 , Ivan De Martino  3   4 , Antongiulio Bruschetta  1 , Salvatore Risitano  5 , Luigi Sabatini  5 , Pietro Cavaliere  1
Affiliations

Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study

Giorgio Cacciola et al. J Clin Med. .

Abstract

Background: C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality.

Methods: We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio.

Results: The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%.

Conclusions: Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker.

Keywords: C-reactive protein; albumin; arthroplasty; early mortality; elderly patients; femoral fractures; femoral nailing; intramedullary nail; total hip arthroplasty.

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Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. This work was performed at the Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy. On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of ROC curved for CAR, CRP, Albumin, creatinine and eFGR.
Figure 2
Figure 2
The percentage of mortality for the increasing value of CAR. There is a direct relationship between the incidence of 30-day mortality and the increasing value of CAR. The incidence of early mortality in patients with an average CAR above 10 is significantly lower when compared with patients with a higher CAR (p < 0.001).
Figure 3
Figure 3
Early mortality (within 30 days of admission), stratified for patients with an average CAR above and below 17.42. Patients with a car below the cut-off value reported a mortality rate of 2.6%, while above the cutoff value was 16.4%.
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