Usefulness of simple biomarkers at admission as independent indicators and predictors of in-hospital mortality in older hip fracture patients.
Injury. 2018 Apr;49(4):829-840. doi: 10.1016/j.injury.2018.03.005. Epub 2018 Mar 8.
Fisher A1, Fisher L2, Srikusalanukul W3, Smith PN4.
- Falls reduced by a third if achieved 40 ng level vitamin D– RCT Sept 2018
- Fall and fracture rates vs Vitamin D after standardization – March 2018
- Hip fractures rates have been increasing since 2012 – Feb 2018
- Trauma with fracture – 2 weeks longer hospital stay if less than 10 ng vitamin D – Jan 2018
- Few Fractures if high Magnesium intake – 2X fewer for men, 2.6X for women – June 2017
- Fracture 4.8 X more likely if low vitamin D, Falls 2.7 X were more likely if low D – Oct 2017
- 1 in 3 died after hip fracture but only 1 in 14 if add Vitamin D and exercise – RCT April 2017
- Total hip replacement: 14 times more likely to redo if low vitamin D – March 2017
Items in both categories Falls/Fractures and Mortality are listed here:
- Deaths due to falls doubled in just a decade (age-adjusted, perhaps decreased vitamin D) – June 2019
- Death of older hip fracture patients at least 1.6X more likely if low vitamin D – May 2018
- Risk of death after bone fracture was 6.6 X higher if less than 10 ng of vitamin D – June 2017
- Vitamin D In Older Women - Fractures, Frailty and Mortality – Buchebner thesis 2017
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- Fewer heart attacks, hip fractures and deaths if more skin cancer – Sept 2013
The data on predictive value of the routinely obtained preoperative biochemical parameters in hip fracture (HF) patients are limited. The aims of this study were to examine in older HF patients (1) the relationships between a broad set of routine laboratory parameters at admission and in-hospital mortality, and (2) evaluate the prognostic value the biomarkers and clinical characteristics (alone or in combination) provide to predict a fatal outcome.
PATIENTS AND METHODS:
In 1820 consecutive patients with low-trauma osteoporotic HF aged >60 years (mean age 82.8 ± 8.1 years; 76.4% women; 65% community-dwelling) 35 laboratory variables along with 20 clinical and socio-demographic characteristics at admission were analysed. The validation cohort included data on 455 older (≥60 years of age) HF patients (mean age 82.1 ± 8.0 years, 72.1% women).
The mortality rate was 6% (n = 109). On univariate analysis 14 laboratory and 8 clinical parameters have been associated with in-hospital mortality. Multiple regression analyses determined 7 variables at admission as independent indicators of a fatal outcome: 4 biomarkers
- (albumin <33 g/L;
- alanine aminotransferase/gamma-glutamyl transferase ratio [GGT/ALT] >2.5;
- parathyroid hormone [PTH] >6.8 pmol/L;
- 25(OH)vitamin D < 25 nmol/L)
and 3 pre-fracture clinical conditions (
- history of myocardial infarction,
- chronic kidney disease [GFR <60 ml/min/1.73 m2] and
- chronic obstructive pulmonary disease);
the area under the receiver operating characteristic curve (AUC) was 0.75 (95%CI 0.70-0.80).
The risk of in-hospital death was 1.6-2.6 times higher in subjects with any of these risk factors (Rfs), and increased by 2.6-6.0-fold in patients with any two RFs (versus no RFs). The mortality rate increased stepwise as the number of RFs increased (from 0.43% -none RF to 16.8%- ≥4RF). The prognostic value of a single RF was low (AUC ≤0.635) but combination of 2 or more RFs improved the prediction significantly; AUC reached 0.84(95%CI 0.77-0.90) when ≥4 RFs (versus 0-1RF) were present. In the validated and main cohorts the number of predicted by 1, 2, 3 or ≥4 RFs and observed deaths were practically similar.
In HF patients, seven easily identifiable at admission characteristics, including 4 biomarkers, are strong and independent indicators of in-hospital mortality and can be used for risk stratification and individualised management.