Frontiers in Medicine · Oct 21, 2026

Admission uric acid to HDL-C ratio and long-term mortality after hip fracture in older adults: a retrospective cohort study

By Han S, Fu YH, Ke C et al.

Objective: To investigate the association between the uric acid to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) and long-term all-cause mortality in elderly patients with hip fractures. Methods: We retrospectively included patients aged 65 years or older who underwent surgery for hip fracture. Admission UHR was calculated from the first available serum uric acid and HDL-C measurements. The primary endpoint was all-cause mortality during follow-up. Cox regression was used for conventional adjusted analyses, and restricted cubic spline and two-piecewise Cox models were used as exploratory analyses of possible nonlinearity. Results: We included 304 patients (104 men and 200 women), with a mean age of 80.00 ± 6.50 years. During a mean follow-up of 34.42 ± 14.76 months, 82 patients died. In the fully adjusted conventional Cox models, UHR was not statistically significant when analyzed as a continuous variable ( P = 0.1413) or by tertiles (high vs. low: HR = 1.54, 95% CI 0.84–2.84, P = 0.1624). In an exploratory two-piecewise model, the estimated inflection point was 166.17. Below this value, higher UHR was associated with higher mortality (HR per unit = 1.01, 95% CI 1.00–1.03, P = 0.0326), whereas the slope above the inflection point was not significant ( P = 0.8050). The likelihood-ratio test comparing the single-slope and two-piecewise models yielded P = 0.037. Conclusion: Admission UHR showed an exploratory nonlinear association with long-term all-cause mortality in this single-center cohort. Because conventional fully adjusted analyses were not statistically significant and the inflection point was derived from the same dataset, UHR should not yet be considered an independent predictor or a validated clinical cutoff. External prospective validation with repeated measurements is required. Clinical Trial Registration: ChiCTR: ChiCTR2200057323.

doi.org/10.3389/fmed.2026.1906596 Open access PubMed 42979666 Biomarkers