Advertisement

International Orthopaedics

, Volume 43, Issue 12, pp 2825–2829 | Cite as

Altered seric levels of albumin, sodium and parathyroid hormone may predict early mortality following hip fracture surgery in elderly

  • Alejandro Lizaur-UtrillaEmail author
  • Blanca Gonzalez-Navarro
  • Maria F. Vizcaya-Moreno
  • Fernando A. Lopez-Prats
Original Paper
  • 84 Downloads

Abstract

Purpose

To analyse a wide set of routine laboratory parameters at admission to predict mortality within 30 post-operative days in elderly patients with hip fracture, as well as calculate the critical values of those biomarkers.

Method

Data of 994 patients older than 65 years with hip fracture were analysed of which 89 (8.2%) died within 30 post-operative days. Variables described in the literature with potential influence on early mortality were collected, including demographics, fracture type, American Society of Anesthesiologists score, Charlson’s comorbidity index and pre-operative Hodkinson’s mental test and the Katz index for activities of daily living. In addition, an exhaustive collection of biomarkers from routine blood testing at admission was performed. Critical levels of biomarkers were calculated by the method of area under ROC curve.

Results

At admission, early mortality group had significantly higher Charlson’s index (p = 0.001) and lower the Katz index (p = 0.001). The surgical delay also was significantly longer in that group (p = 0.001). In univariate analyses, serum concentration at admission of total protein (p = 0.004), albumin (p = 0.001), sodium (p = 0.001), and parathyroid hormone (PTH) (p = 0.001) were significantly different between both groups. In multivariate analysis, serum albumin < 2.9 g/dL (p = 0.013), sodium < 127 mEq/L (p = 0.035) and PTH > 65 pg/mL (p = 0.005) were predictors of early mortality. The three biomarkers together accounted for 67% of the variability in early mortality.

Conclusion

The association of altered levels at admission of serum concentration of albumin, sodium and PTH was predictor of early mortality following hip fracture surgery in elderly patients.

Keywords

Early mortality Biomarkers Routine blood testing Hip fracture Elderly 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required by our institutional review board.

References

  1. 1.
    Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43:676–685.  https://doi.org/10.1016/j.injury.2011.05.017 CrossRefPubMedGoogle Scholar
  2. 2.
    Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A (2013) Predictors of early mortality after hip fracture surgery. Int Orthop 37:2119–2124.  https://doi.org/10.1007/s00264-013-2068-1 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Menéndez-Colino R, Alarcon T, Gotor P, Queipo R, Ramírez-Martín R, Otero A, González-Montalvo JI (2018) Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA cohort). Injury 49:656–661.  https://doi.org/10.1016/j.injury.2018.01.003 CrossRefPubMedGoogle Scholar
  4. 4.
    Nkanang B, Parker M, Parker E, Griffiths R (2017) Perioperative mortality for patients with a hip fracture. Injury 48:2180–2183.  https://doi.org/10.1016/j.injury.2017.07.007 CrossRefPubMedGoogle Scholar
  5. 5.
    Omari A, Madsen CM, Lauritzen JB, Jørgensen HL, Vojdeman FJ (2019) Comorbidity and mortality after hip fracture in nineteen thousand six hundred and eighty two patients aged eighteen to sixty five years in Denmark from 1996 to 2012. Int Orthop.  https://doi.org/10.1007/s00264-019-04323-z CrossRefGoogle Scholar
  6. 6.
    Aldebeyan S, Nooh A, Aoude A, Weber MH, Harvey EJ (2017) Hypoalbuminaemia-a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. Injury 48:436–440.  https://doi.org/10.1016/j.injury.2016.12.016 CrossRefPubMedGoogle Scholar
  7. 7.
    Laulund AS, Lauritzen JB, Duus BR, Mosfeldt M, Jørgensen HL (2012) Routine blood tests as predictors of mortality in hip fracture patients. Injury 43:1014–1020.  https://doi.org/10.1016/j.injury.2011.12.008 CrossRefPubMedGoogle Scholar
  8. 8.
    Seyedi HR, Mahdian M, Khosravi G, Bidgoli MS, Mousavi SG, Razavizadeh MR, Mahdian S, Mohammadzadeh M (2015) Prediction of mortality in hip fracture patients: role of routine blood tests. Arch Bone Jt Surg 3:51–55PubMedPubMedCentralGoogle Scholar
  9. 9.
    Fisher A, Fisher L, Srikusalanukul W, Smith PN (2018) Usefulness of simple biomarkers at admission as independent indicators and predictors of in-hospital mortality in older hip fracture patients. Injury.  https://doi.org/10.1016/j.injury.2018.03.005 CrossRefGoogle Scholar
  10. 10.
    American Society of Anesthesiologists (2017) Relative value guide. Online http://www.asahq.org. Accessed 26 June 2017
  11. 11.
    Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251CrossRefGoogle Scholar
  12. 12.
    Hodkinson HM (1972) Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 4:233–238CrossRefGoogle Scholar
  13. 13.
    Katz S, Ford A, Moskowitz R, Jackson B, Jaffe M (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 185:914–919CrossRefGoogle Scholar
  14. 14.
    Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ (2017) Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am 99:2110–2118.  https://doi.org/10.2106/JBJS.16.01620 CrossRefPubMedGoogle Scholar
  15. 15.
    Madsen CM, Jantzen C, Lauritzen JB, Abrahamsen B, Jorgensen HL (2016) Hyponatremia and hypernatremia are associated with increased 30-day mortality in hip fracture patients. Osteoporos Int 27:397–404.  https://doi.org/10.1007/s00198-015-3423-4 CrossRefPubMedGoogle Scholar
  16. 16.
    Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A (2006) 25-Hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients. J Bone Miner Metab 24:42–47.  https://doi.org/10.1007/s00774-005-0644-1 CrossRefPubMedGoogle Scholar
  17. 17.
    Fisher A, Goh S, Srikusalanukul W, Davis M (2009) Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. Calcif Tissue Int 85:301–309.  https://doi.org/10.1007/s00223-009-9283-1 CrossRefPubMedGoogle Scholar
  18. 18.
    Lee HP, Chang YY, Jean YH, Wang HC (2009) Importance of serum albumin level in the preoperative tests conducted in elderly patients with hip fracture. Injury 40:756–759.  https://doi.org/10.1016/j.injury.2009.01.008 CrossRefPubMedGoogle Scholar
  19. 19.
    Avenell A, Smith TO, Curtain JP, Mak JC, Myint PK (2016) Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev 11:CD001880.  https://doi.org/10.1002/14651858.CD001880.pub6 CrossRefPubMedGoogle Scholar
  20. 20.
    Bhaskar D, Parker MJ (2011) Haematological indices as surrogate markers of factors affecting mortality after hip fracture. Injury 42:178–182.  https://doi.org/10.1016/j.injury.2010.07.501 CrossRefPubMedGoogle Scholar
  21. 21.
    Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, Johnston DW (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 20:494–500.  https://doi.org/10.1359/JBMR.041133 CrossRefPubMedGoogle Scholar
  22. 22.
    Belmont PJ Jr, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ (2014) Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 134:597–604.  https://doi.org/10.1007/s00402-014-1959-y CrossRefPubMedGoogle Scholar
  23. 23.
    Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ (2015) Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J 97:246–251.  https://doi.org/10.1302/0301-620X.97B2.35248 CrossRefPubMedGoogle Scholar
  24. 24.
    Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Parreño S, Lopez-Prats FA (2019) Reasons for delaying surgery following hip fractures and its impact on one year mortality. Int Orthop.  https://doi.org/10.1007/s00264-018-3936-5 CrossRefGoogle Scholar
  25. 25.
    Wong SHJ, Fang XC, Yee KHD, Wong TM, Pun CTT, Lau TW, Leung KLF (2018) Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing. Int Orthop 42:1789–1794.  https://doi.org/10.1007/s00264-017-3737-2 CrossRefPubMedGoogle Scholar
  26. 26.
    Civinini R, Paoli T, Cianferotti L, Cartei A, Boccaccini A, Peris A, Brandi ML, Rostagno C, Innocenti M (2019) Functional outcomes and mortality in geriatric and fragility hip fractures-results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”. Int Orthop 43:187–192.  https://doi.org/10.1007/s00264-018-4132-3 CrossRefPubMedGoogle Scholar
  27. 27.
    Moyet J, Deschasse G, Marquant B, Mertl P, Bloch F (2019) Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice. Int Orthop 43:1449–1454.  https://doi.org/10.1007/s00264-018-3928-5 CrossRefPubMedGoogle Scholar
  28. 28.
    Forni C, Gazineo D, D'Alessandro F, Fiorani A, Morri M, Sabattini T, Ambrosi E, Chiari P (2019) Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. Int Orthop 43:275–281.  https://doi.org/10.1007/s00264-018-4057-x CrossRefPubMedGoogle Scholar
  29. 29.
    Ayubi E, Safiri S (2018) Comments on “mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis”. Int Orthop 42:441–442.  https://doi.org/10.1007/s00264-017-3668-y CrossRefPubMedGoogle Scholar
  30. 30.
    Carow J, Carow JB, Coburn M, Kim BS, Bücking B, Bliemel C, Bollheimer LC, Werner CJ, Bach JP, Knobe M (2018) Response to “comments on mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis”. Int Orthop 42:967–968.  https://doi.org/10.1007/s00264-017-3755-0 CrossRefPubMedGoogle Scholar
  31. 31.
    Eneroth M, Olsson UB, Thorngren KG (2006) Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 451:212–217.  https://doi.org/10.1097/01.blo.0000224054.86625.06 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryElda University HospitalAlicanteSpain
  2. 2.Traumatology and OrthopaedicsMiguel Hernandez UniversityAlicanteSpain
  3. 3.Clinical Research Group, Faculty of Health SciencesUniversity of AlicanteAlicanteSpain

Personalised recommendations