Association between markers of inflammation and outcomes after hip fracture surgery: analysis of routinely collected electronic healthcare data

被引：0
作者：
Shivam N. Kolhe [1 ]
Richard Holleyman [2 ]
Andrew Chaplin [3 ]
Sarah Langford [3 ]
Mike R. Reed [4 ]
Miles D. Witham [3 ]
Antony K. Sorial [3 ]
机构：
[1] AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne
[2] NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne
[3] Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumbria House, Cobalt Business Park, Newcastle upon Tyne
[4] Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
[5] Institute for Cell and Molecular Biosciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
来源：
BMC Geriatrics | / 25卷 / 1期
关键词：
Albumin; Biomarkers; CRP; Frailty; Hip fracture; Inflammation; Post-operative outcomes; Prognostication;
D O I：
10.1186/s12877-025-05939-0
中图分类号：
学科分类号：
摘要：
Background: Risk assessment tools such as the Nottingham Hip Fracture Score (NHFS) are crucial in guiding prognostic discussions and benchmarking in hip fracture care. These scores have scope to be improved, which may help identify higher-risk patients at admission. We investigated the role of inflammatory biomarkers, which are routinely collected at admission, in predicting post-operative outcomes following hip fracture. We subsequently combined these biomarkers with the NHFS to see if we could enhance risk prediction. Methods: We analysed data from patients admitted to a trauma unit with hip fracture between 2015 and 2020 who underwent operative management. National hip fracture database (NHFD) data, including the NHFS, were linked with admission biomarkers: albumin, C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR). Following univariate and multivariate analyses, the discrimination of the NHFS with and without each biomarker was assessed for 30-day mortality, length of stay (LOS), and failure to return home at 30 days. Results: We analysed 1039 patients, 719 (69.2%) were female and the mean age was 82.5 years (SD 8.1, range 60–104). In multivariate analysis, higher CRP was associated with higher 30-day mortality (odds ratio (OR) 1.23, 95%, confidence interval (CI) 1.04–1.44, p = 0.013); higher albumin was associated with lower 30-day mortality (OR 0.86, 95%CI 0.81–0.91, p < 0.001). Independent predictors of not returning home at 30 days included albumin (OR 0.94, 95% CI 0.91–0.98) and NLR (OR 1.44, 95% CI 1.14–1.81). NLR and MLR were significantly associated with prolonged LOS but not 30-day mortality. A composite variable of NHFS and albumin had better discrimination for 30-day mortality than NHFS alone (c-statistics 0.74, 95% CI 0.68–0.80 vs. 0.68, 95% CI 0.62–0.75, respectively). CRP, NLR and MLR did not improve discrimination for any outcome when added to NHFS. Conclusions: Albumin, but not other markers of inflammation, enhances risk prediction after hip fracture when added to the NHFS. Routine recording of albumin at admission may have a future role in an enhanced risk scoring system for prognostication in hip fracture surgery. © The Author(s) 2025.
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  • [1] RCP) RCoP. Improving Understanding: The National Hip Fracture Database Report on 2021, (2022)
  • [2] Judge A., Javaid M.K., Leal J., Hawley S., Drew S., Sheard S., Prieto-Alhambra D., Gooberman-Hill R., Lippett J., Farmer A., Et al., Models of care for the delivery of secondary fracture prevention after hip fracture: A health service cost, clinical outcomes and cost-effectiveness study within a region of England, 4, (2016)
  • [3] Moppett I.K., Wiles M.D., Moran C.G., Sahota O., The Nottingham hip fracture score as a predictor of early discharge following fractured neck of femur, Age Ageing, 41, 3, pp. 322-326, (2011)
  • [4] Ferris H., Brent L., Sorensen J., Ahern E., Coughlan T., Discharge destination after hip fracture: findings from the Irish hip fracture database, Eur Geriatr Med, 13, 2, pp. 415-424, (2022)
  • [5] Dhanwal D.K., Dennison E.M., Harvey N.C., Cooper C., Epidemiology of hip fracture: worldwide geographic variation, Indian J Orthop, 45, 1, pp. 15-22, (2011)
  • [6] Neuburger J., Currie C., Wakeman R., Tsang C., Plant F., De Stavola B., Cromwell D.A., van der Meulen J., The impact of a National clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data, Med Care, 53, 8, pp. 686-691, (2015)
  • [7] Maxwell M.J., Moran C.G., Moppett I.K., Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery, Br J Anaesth, 101, 4, pp. 511-517, (2008)
  • [8] Doherty W.J., Stubbs T.A., Chaplin A., Reed M.R., Sayer A.A., Witham M.D., Sorial A.K., Prediction of postoperative outcomes following hip fracture surgery: independent validation and recalibration of the Nottingham hip fracture score, J Am Med Dir Assoc, 22, 3, pp. 663-660, (2021)
  • [9] Dalle S., Rossmeislova L., Koppo K., The role of inflammation in Age-Related sarcopenia, Front Physiol, 8, (2017)
  • [10] Clegg A., Young J., Iliffe S., Rikkert M.O., Rockwood K., Frailty in elderly people, Lancet, 381, 9868, pp. 752-762, (2013)
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