Therapeutics and Clinical Risk Management · Jan 1, 2026

Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Predictor of Mortality in Patients with Femoral Fracture: A Retrospective Cohort Analysis

By Kuo PJ, Wu SC, Hsu SY et al.

BACKGROUND: Femoral fractures carry high mortality in elderly patients. The aspartate aminotransferase-to-platelet ratio index (APRI), a noninvasive liver function marker, may reflect physiological vulnerability. Its prognostic role in trauma remains unclear. METHODS: We retrospectively analyzed 4,310 adult patients (2009-2023) with femoral fractures undergoing surgery. APRI was calculated on admission. The primary outcome was in-hospital mortality. Multivariable logistic regression and ROC analysis identified independent predictors and optimal APRI cut-off. RESULTS: Among 4,310 patients, 85 (2.0%) died in-hospital. Non-survivors had significantly higher APRI (1.4±1.5 vs 0.7±2.1, p = 0.008), higher AST levels, and greater injury severity. APRI independently predicted mortality (adjusted OR 1.57 per unit, 95% CI 1.41-1.98, p = 0.023). ROC analysis yielded an AUC of 0.670. An APRI ≥0.74 provided 55% sensitivity and 78% specificity. Patients with APRI ≥0.74 had higher mortality (4.9% vs 1.1%, adjusted OR 2.82, p < 0.001) and longer hospital stays. CONCLUSION: Given APRI's moderate predictive value for adverse outcomes, we cautiously recommend including APRI in preoperative risk assessment for hip fracture patients. This approach may help identify high-risk cases for targeted interventions.

doi.org/10.2147/tcrm.s553629Open accessPubMed 41868411Biomarkers