AST/ALT ratio as a potential predictor of 1-year mortality in elderly patients operated for femoral neck fracture

Abstract

Purpose: Hip fractures in elderly individuals are associated with high mortality rates, even with advanced treatment options. Identifying factors correlated with mortality could guide potential preventive strategies. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, as well as the AST/ALT ratio (AAR), have been associated with mortality in various diseases, but their association with hip fracture mortality remains underexplored. This study investigates the correlation between AST, ALT, AAR, and routine laboratory parameters with 1-year mortality in elderly patients undergoing partial hip arthroplasty for femoral neck fractures. Methods: This retrospective cohort study analyzed data from 179 elderly patients (≥60 years) who underwent partial hip replacement for femoral neck fracture between January 2019 and December 2021. Results: Of the 179 patients, 29.6% died within one year of surgery. The deceased patients were older, predominantly male, and had higher rates of postoperative complications and transfusions. Univariate analysis identified age, sex, blood type, comorbidities, postoperative complications, transfusions, and laboratory parameters (including AAR, creatinine, and lymphocyte count) as associated with mortality. Multivariate analysis further highlighted advanced age, male sex, blood group A, postoperative transfusions, elevated creatinine levels, and high AAR (>2.1) as independent predictors of mortality. Conclusion: Our findings suggest that preoperative AAR may serve as an independent predictor of mortality in elderly patients undergoing hip fracture surgery, highlighting its potential utility in preoperative risk stratification.