What is the clinical evidence from this study?

Study design: Observational. Population: Hip fracture (n=1770). Intervention: High creatinine-to-albumin ratio (≥1.9) vs. Low creatinine-to-albumin ratio (<1.9). Primary outcome: 1-year mortality after surgery (HR 1.49, 95% CI 1.02-2.17, p=0.039).

February 12, 2026Open Access

Association of serum high creatinine-to-albumin ratio with increased 1-year mortality in older patients following hip fracture surgery

Q: What are the key findings of this study?

A high preoperative serum creatinine-to-albumin ratio was independently associated with increased 1-year mortality (HR 1.49) compared to a low ratio in older patients following hip fracture surgery.

Q: What does this research mean for the field?

High serum creatinine-to-albumin ratio is independently associated with increased 1-year mortality in older patients following hip fracture surgery. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between serum creatinine-to-albumin ratio and 1-year mortality in older patients post-hip fracture surgery.

PJPeiPei JinSecond Military Medical University JHJian HuangShanghai University WYWeian YuanGuiyang Medical University

Key Result

A high preoperative serum creatinine-to-albumin ratio was independently associated with increased 1-year mortality (HR 1.49) compared to a low ratio in older patients following hip fracture surgery.

Key Points

To evaluate the association between serum creatinine-to-albumin ratio and 1-year mortality in older patients post-hip fracture surgery.
Retrospective study design
Inclusion of older patients undergoing hip fracture surgery
Measurement of serum creatinine and albumin at admission
Analysis of 1-year mortality using Kaplan–Meier curves and Cox regression modeling
Mean age of participants was 79.5 years
1-year mortality rate post-surgery was 8.6%
High creatinine-to-albumin ratio associated with increased mortality (hazard ratio = 1.49)
Kaplan–Meier analysis shows higher mortality in high CAR group (p < 0.0001)

Study Design

Type

Observational (n=1,770)

Multicenter

Structured PICO

Does a high preoperative serum creatinine-to-albumin ratio predict increased 1-year mortality in older patients following hip fracture surgery?

Population

1,770 older patients (age ≥65 years) undergoing hip fracture surgery (femoral neck or intertrochanteric fractures), mean age 79.4 ± 8.1 years, 31.4% male. Excluded patients with multiple fractures, renal function impairment (eGFR <60), and dementia.

Intervention

High preoperative serum creatinine-to-albumin ratio (CAR ≥ 1.9)

Comparator

Low preoperative serum creatinine-to-albumin ratio (CAR < 1.9)

Outcome

1-year mortality after surgeryhard clinical

A high preoperative serum creatinine-to-albumin ratio is an independent predictor of 1-year mortality in older patients undergoing hip fracture surgery.

Main Result

Effect estimate: HR 1.49 (95% CI 1.02-2.17)

p-value: p=0.039

Limitations

Single-center retrospective design limits generalizability and causal inference
Potential unmeasured confounders such as variations in clinical care, postoperative complications, and socioeconomic factors
Exclusion of patients with eGFR <60 mL/(min × 1.73 m2) limits generalizability to those with moderate-to-severe kidney disease
CAR levels were only measured preoperatively and not tracked postoperatively

Abstract

Background Creatinine-to-albumin ratio (CAR) was associated with short-term and long-term prognosis in various clinical settings. However, the relation of CAR with prognosis in older patients with hip fracture remains unclear. Methods This retrospective study was performed in older patients undergoing hip fracture surgery in our hospital from January 2018 to December 2023. Serum creatinine and albumin were recorded at admission. The primary outcome was 1-year mortality after surgery in patients with hip fracture. The association between preoperative serum creatinine-to-albumin ratio and 1-year mortality was assessed by Kaplan–Meier curves, Cox regression models, and stratified analyses. Results The mean age of the participants was 79.5 ± 8.1 years and the median CAR was 1.9 (1.5–2.4). The prevalence of 1-year mortality following hip fracture surgery was 8.6%. Multivariate Cox regression analysis indicated that high CAR was independently associated with increased 1-year mortality (hazard ratio = 1.49; 95% confidence interval = 1.02–2.17) after adjusting for covariates. In addition, Kaplan–Meier curve analyses indicated that patients with the high CAR had a higher 1-year mortality than that with low CAR ( p 0.0001). Subgroup analyses showed that the association was similar across all subgroups. Conclusion The CAR can serve as an independent prognosis indicator for 1-year mortality in older patients following hip fracture surgery. However, researchers are required to confirm the findings in the future.

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