Objective To investigate the clinical value of preoperative ratio of C-reactive protein to albumin (CRP/Alb) in predict-ing 1-year mortality after hip fracture in the elderly patients. Methods A retrospective analysis was made of the clinical data of the elderly patients with hip fracture, who underwent orthopedic surgery at the Chinese PLA Central Theater General Hospital from January 2015 to August 2017. According to whether the patient died within 1 year after surgery, the patients were divided into survival group and death group. Multivariate logistic regression was performed to explore independent risk factors for death within 1 year after surgery. The receiver operating charactersitic (ROC) curve and Kaplan-Meier method were used to analyze the value of CRP/Alb in evaluating poor prognosis in the elderly patients with hip fracture. Results A total of 165 patients were enolled in the final study, and the cumulative mortality rate was 20.61% within 1 year after surgery. Univariate analysis showed that the survival group had significantly higher age, red blood cell distribution width, CRP, CRP/Alb, rate of concomitant chronic lung disease and ASA grade but lower Alb than the death group, the difference being of statistical significance (P<0.05). Multivariate analysis showed that CRP/Alb (OR=2.472,95％CI 1.100-5.554) was an important risk factor for predicting death in the elderly patients with hip fracture within 1 year after surgery. AUC of CRP/Alb in predicting the poor prognosis was 0.949 (P<0.001,5%CI 0.915-0.984), which was significantly higher than the single-index prediction of CRP or Alb. When CRP/Alb of 3.05 was set as the optimal cut-off value, the patients were divided into high-ratio group (n=37) and low-ratio group (n=128). The former had significantly shorter survival than the latter, the difference being statistically significant (χ²=48.607, P<0.001). Conclusion CRP/Alb is an independent risk factor for predicting death within 1 year after surgery in the elderly patients with hip fracture and can be used as an effective indicator for predicting adverse clinical outcomes.