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 24h 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.