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Serum cystatin C as a biomarker to predict all-cause mortality in geriatrics hip fracture
Bin-Fei Zhang1, Lin Liu1, Ke Xu1
1Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Insights
Preoperative cystatin C levels predict mortality risk in older adults with hip fractures. Higher levels, particularly above 1.62 mg/L, are associated with increased all-cause mortality.
Area of Science:
- Geriatric Medicine
- Biomarkers
- Epidemiology
Background:
- Cystatin C, a cysteine protease inhibitor, is a reliable indicator of renal function, independent of age, sex, or muscle mass.
- Its utility extends to predicting health outcomes in elderly populations, including those with hip fractures.
Purpose of the Study:
- To investigate the association between preoperative cystatin C levels and all-cause mortality in patients who sustained hip fractures.
- To determine if cystatin C can serve as a prognostic biomarker in this specific patient cohort.
Main Methods:
- A cohort of 2,394 geriatric hip fracture patients was analyzed.
- Demographic and clinical data were collected, and survival analysis was performed using linear and non-linear multivariate Cox regression models.
- Propensity score-matching was employed for sensitivity analysis.
Main Results:
- A significant non-linear relationship was observed between preoperative cystatin C levels and all-cause mortality.
- Mortality risk increased significantly with cystatin C levels below 1.62 mg/L (HR=2.60).
- The highest mortality risk was noted at cystatin C levels exceeding 1.62 mg/L, with a sustained elevated risk thereafter.
Conclusions:
- Preoperative cystatin C levels demonstrate a non-linear predictive value for mortality in geriatric hip fracture patients.
- Cystatin C is a valuable biomarker for assessing mortality risk in this population.
- Study registration: ChiCTR2200057323.
Background:
Cystatin C, a low-molecular-weight protein, belongs to cysteine protease inhibitors produced primarily by nucleated cells. Its serum concentration, independent of sex, age, or muscle mass, is a good predictor of renal dysfunction in older adults. This study evaluated the association between all-cause mortality and preoperative cystatin C levels in hip fractures.
Materials And Methods:
Data describing the demographic and clinical characteristics of the patients were gathered specifically from older individuals who had suffered hip fractures. The study used linear and non-linear multivariate Cox regression models to investigate the association between preoperative cystatin C levels and mortality. The analyses were conducted using the R and EmpowerStats software.
Results:
In total, two thousand three hundred and ninety-four patients were included in this study. A total of 790 patients (33 %) died of all causes. The mean follow-up was 37.62 months. The preoperative cystatin C was 0.91 ± 0.41 mg/L. Linear multivariate Cox regression analysis revealed a significant association between preoperative cystatin C level and death, with a hazard ratio (HR) of 2.19 (95 % confidence interval [CI]: 1.72-2.79, P < 0.0001). Nevertheless, the correlation between the variables was inconsistent. A cystatin C concentration of 1.62 mg/L marked a significant change in the non-linear relationship. A preoperative cystatin C level below 1.62 mg/L was found to be significantly linked with an increased risk of mortality (HR = 2.60, 95 % CI: 1.92-3.52, P < 0.0001). The mortality reached its highest point when the preoperative cystatin C level was greater than 1.62 mg/L. After that, the mortality risk did not increase further (HR = 1.54, 95 % CI: 0.98-2.42, P = 0.0588). The non-linear relationship remained consistent in the propensity score-matching sensitive analysis.
Conclusions:
The study found a non-linear relationship between preoperative cystatin C levels and mortality in geriatric hip fractures. This suggests that preoperative cystatin C can be used as a predictor of the risk of death. The registration number is ChiCTR2200057323.
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