Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture

Abstract

Background The sarcopenia index (SI), calculated as the ratio of serum creatinine to cystatin C levels, reflects skeletal muscle mass and strength. Patients with hip fracture (HF) and sarcopenia have poor functional outcomes, and many require long‐term care after surgery. We hypothesized that the SI can predict preoperative and early postoperative functional outcomes. Methods Preoperative serum creatinine and cystatin C were measured to calculate the SI for patients with surgically treated HF (n = 130, mean age: 87.8 ± 6.9 years). Walking ability before and 2 weeks after surgery was assessed, and patients were dichotomized into independent and assistance groups. To assess the validity of the SI, we examined its correlation with the quality [computed tomography (CT) value] and quantity (cross‐sectional area) of the muscles around the hip on the non‐operated side, which were preoperatively measured using CT. Receiver operating characteristic (ROC) analysis was performed to evaluate the prognostic value of the SI. Results The SI of the preoperative independent (n = 77) and assistance groups (n = 53) significantly differed (70.2 ± 12.4 and 60.1 ± 9.8, respectively, P < 0.000001). At 2 weeks after surgery, the SI was significantly higher in the independent group (n = 31, 73.0 ± 14.9) than in the assistance group (n = 99, 64.0 ± 10.7, P = 0.0003). In the preoperative independent group, 28 could walk independently after surgery (SI: 74.8 ± 14.0) while 49 required assistance (SI: 67.7 ± 10.6, P = 0.01). For patients with femoral neck fracture (FNF), the SIs were significantly higher in the postoperative independent group (78.6 ± 15.7) than in the postoperative assistance group (63.2 ± 10.9, P = 0.002). Logistic regression analysis showed that the odds ratio (95% confidence interval) of the SI for postoperative walking ability was 0.95 (0.91–0.99, P = 0.03). The correlations of SIs with CT values and cross‐sectional areas were as follows: iliopsoas at the apex of the femoral head, r = 0.40, P < 0.001 and r = 0.49, P < 0.001, respectively; rectus femoris at the level of the lessor trochanter, r = 0.26, P = 0.007 and r = 0.37, P < 0.001, respectively. ROC analysis for predicting postoperative walking ability in preoperative independent patients with HF and FNF revealed areas under the curve (95% confidence interval) of 0.63 (0.50–0.76) and 0.80 (0.65–0.96), respectively. Conclusions In patients with HF, the SI correlated with preoperative walking ability and could predict postoperative walking ability. Among patients who could walk independently before surgery, those with high SIs could walk independently early in the postoperative period. The SI is beneficial for estimating walking ability in patients with HF.

Relationship between serum creatinine to cystatin C ratio and subclinical atherosclerosis in patients with type 2 diabetes

“…Sarcopenia is reported to be associated with a risk of atherosclerosis,30–34 CVD9 35–38 and mortality 10–12. Recent studies showed that SI is useful marker for sarcopenia and physical activity levels 13–15 39. In addition, SI is reported to be associated with incident CVD17 18 and mortality 17 40–42.…”

Bilateral Incomplete Atypical Femur Fractures with Severe Bowing Treated Using Elastic Intramedullary Nails

“…In summary, this case report showed that an older patient with bilateral symptomatic incomplete AFFs and severe anterolateral bowing was successfully treated using stainless elastic intramedullary nails. n Naoki Okubo, MD, PhD 1,2 Takashi Yoshida, MD, PhD 1 Kazuya Tanaka, MD 1 Mizuki Asano, MD 1 Taku Nakazawa, MD 1 Masato Ohara, MD 1,2 Kunihiko Hosoi, MD, PhD 1 Kenji Takahashi, MD, PhD 2…”

“…Fragility fractures, such as hip and vertebral fractures, have negative impacts on functional outcomes and mortality 1,2 . Treatment of osteoporosis with bone resorption inhibitors resulted in significant benefits in fracture prevention and life expectancy 3 ; however, their long-term use has been associated with atypical fractures 4 .…”

Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study

“…The FIM walk item is scored on a 7-point scale with scores ranging from 1 to 7, with a higher score indicating a higher degree of independence. As described in previous studies, the ‘independent’ group included patients who scored ≥6 points for the FIM walk item, whereas the ‘non-independent’ group included patients who scored ≤5 points for the FIM walk item [9]. The assessments were performed at discharge by the same physical therapist who had supervised the rehabilitation.…”

“…It is imperative to understanding the factors influencing postoperative ambulatory function before surgical intervention to establish a comprehensive treatment strategy for postoperative walking independence following HF surgery. Baseline and preoperative clinical factors, such as age [7], preadmission walking independence [8], fracture type [9], operative delay [10], anemia [11] and nutritional status [12], have been reported to be associated with postoperative walking independence in patients with HF. Thus, it is difficult to predict postoperative walking independence in patients with HF using one or two single factors, necessitating the analysis of multiple factors [13].…”