Abstract
BACKGROUND: Sarcopenia is prevalent in older adults with hip fracture and is associated with poor postoperative outcomes. This study aimed to evaluate the prognostic value of sarcopenia index (SI) and creatinine-cystatin C ratio (CCR) in predicting postoperative mortality in older patients with hip fracture. METHODS: A retrospective study was conducted on 485 older adults (aged ≥ 65 years) with hip fracture treated at Zhongda Hospital between January 2018 and December 2022. SI and CCR were calculated using serum creatinine and cystatin C. The primary outcome was all-cause mortality at 1, 3, and 12 months. RESULTS: Among the 485 patients, 46 (9.5%) died within one year. Both SI and CCR presented positive and significant correlations with muscle mass and density, while SI showed a stronger association than CCR. Propensity score matching confirmed that patients in the lowest SI tercile had significantly higher 1-month, 3-month, and 12-month mortality compared to those in the highest ones (7.2% vs. 0%, 10.8% vs. 2.4%, and 19.3% vs. 8.4%). ROC analyses indicated that SI had a moderate predictive accuracy for mortality, with AUCs of 0.745 (95% CI 0.628-0.862), 0.684 (95% CI 0.589-0.779), and 0.617 (95% CI 0.536-0.697) for 1-month, 3-month, and 12-month mortality, respectively. In addition, SI showed a higher predictive accuracy for postoperative mortality in the early period and in females. CONCLUSION: SI is a reliable and useful marker for predicting short-term mortality in older adults with hip fracture, which can serve as a valuable tool for early diagnosis and intervention in the future.