Muscle point-of-care ultrasound as a predictor of mortality in older adults with hip fracture.

PURPOSE: Lower-limb muscle thickness assessed by point-of-care ultrasound (POCUS) is emerging as a prognostic marker in older adults, but evidence in patients with hip fracture is limited. This study aimed to investigate whether POCUS of the vastus lateralis (VL) muscle could predict one-year all-cause mortality in older adults with hip fracture, and to identify the VL thickness cut-off with the highest prognostic performance.

METHODS

We conducted a prospective observational study involving patients ≥ 65 years hospitalized for proximal hip fracture at Careggi University Hospital, Florence, Italy, between January 2024 and July 2024 Participants underwent comprehensive geriatric assessment and VL POCUS within 24 h of admission. The study outcome was one-year all-cause mortality. Predictive performance of VL thickness was assessed using ROC curve analysis and multivariate logistic regression.

RESULTS

Among 154 patients (mean age 86.5 years, 70.1% female), one-year mortality was 42.2%. Mortality was associated with older age, functional and motor impairment, frailty, malnutrition, and higher comorbidity burden. ROC analysis demonstrated good predictive ability of VL thickness (AUC = 0.702), with a cut-off value of < 1.12 cm providing the best discriminative performance (sensitivity 68%, specificity 64%). Patients with reduced VL thickness showed higher mortality (57.9% vs 26.9%, p < 0.001). VL thickness < 1.12 cm independently predicted mortality, after adjusting for age, nutritional status, pre-fracture functional level and comorbidity burden.

CONCLUSIONS

In older adults hospitalized for hip fracture, VL thickness of < 1.12 cm independently predicted one-year all-cause mortality, suggesting a potential role of muscle POCUS as a prognostic tool in the orthogeriatric setting.