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Garća-Alvarez F, Chueca-Marco Á, Martínez-Lostao L, Aso-Gonzalvo M, Estella-Nonay R, Albareda J. Serum levels of IL-6 and IL-10 on admission correlate with complications in elderly patients with hip fracture. Injury 2024:111736. [PMID: 39068064 DOI: 10.1016/j.injury.2024.111736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/02/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Ageing may cause a progressive pro-inflammatory environment and alter functionality of different immune-cell populations. The aim of the present study is to examine the influence of certain serum immunological parameters on hospitalization stay and complications in patients who have suffered a hip fracture. PATIENTS AND METHODS A prospective study was carried out with 87 patients (63 women) presenting with either trochanteric femoral fracture or Garden IV displaced subcapital fracture. The average age was 84.43 ± 9, ranging from 65 to 104 years old. Data regarding different comorbidities were recorded at the time of arrival. The morning after patient's admission peripheral blood samples were obtained and a series of immunological parameters were determined: leukocyte formula, platelets count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 levels, T-lymphocytes count, number of cells/mm3 and percentages of CD3, CD4, CD8, CD3-/CD16/56+ (NK cells), and CD3-/CD19+ (B cells). RESULTS IL-6 serum levels presented a positive and significant correlation with higher levels of CRP (p < 0.001), IL-10 (p = 0.002), and higher percentages of NK CD56+ cells (p = 0.046). IL-6 serum levels at hospitalization presented a positive and significant correlation with a longer hospitalization stay (p = 0.037). Hospitalization increased by 0.231 days for every 1 pg/mL above the IL-6 mean value (40.43 pg/mL). Lower serum IL-10 levels on admission were associated with the appearance of symptomatic urinary tract infection during hospitalization (p = 0.032). Higher number of CD19+ cells/mm3 presented a significant relationship with pneumonia (p = 0.018) and symptomatic urinary tract infection (p = 0.0019). CONCLUSIONS IL-6 serum levels on admission showed a positive and significant correlation with a longer hospitalization stay in elderly patients presenting with hip fracture. Lower levels of IL-10 in peripheral blood on admission were associated with symptomatic urinary tract infections. A higher number of CD19+ cells/mm³ was significantly associated with pneumonia and symptomatic urinary tract infection. These immunological variables on admission may serve as risk indicators of complications during hospitalization.
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Affiliation(s)
- Feĺcito Garća-Alvarez
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain; University of Zaragoza, Zaragoza, Spain.
| | - Álvaro Chueca-Marco
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Luis Martínez-Lostao
- University of Zaragoza, Zaragoza, Spain; Department of Immunology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | | | - Ruben Estella-Nonay
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Jorge Albareda
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain; University of Zaragoza, Zaragoza, Spain
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Meng L, Wang X, Carson JL, Schlussel Y, Shapses SA. Vitamin D Binding Protein and Postsurgical Outcomes and Tissue Injury Markers After Hip Fracture: A Prospective Study. J Clin Endocrinol Metab 2023; 109:e18-e24. [PMID: 37633261 PMCID: PMC10735285 DOI: 10.1210/clinem/dgad502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Abstract
CONTEXT Hip fracture is a serious injury that can lead to increased morbidity and mortality. Vitamin D binding protein (DBP) is a potential prognostic indicator of outcomes since it is important for actin scavenging and inflammation after tissue injury. OBJECTIVE To determine whether circulating DBP is associated with mobility or mortality after hip fracture and its association with acute tissue injury markers. METHODS Post hoc analysis of a multisite North American prospective study of 260 patients with hip fracture; mobility assessed at 30 and 60 days and mortality at 60 days after repair surgery. Biochemical markers were measured before, and 2 to 4 days after surgery. Tissue injury markers were measured in 100 randomly selected patients and controls. The primary outcome was mobility and mortality by DBP tertiles. Secondary outcomes were assessment of pre- and postoperative biomarkers. RESULTS Among all patients (81 ± 9 years, BMI 25 ± 4 kg/m2; 72% female), the highest DBP tertile had greater mobility at 30 (OR: 2.66; 95% CI: 1.43, 4.92; P = .002) and 60 days (OR: 2.31; 95% CI: 1.17, 4.54; P = .014) and reduced mortality (OR: 0.18; 95% CI: 0.04, 0.86; P = .032) compared with the lowest DBP tertile (<28.0 mg/dL). Total 25-hydroxyvitamin-D did not differ between tertiles (22.0 ± 9.5 ng/mL). Circulating DBP and gelsolin were lower and interleukin-6, C-reactive protein, and F-actin were higher (P < .01) in patients vs controls, and worsened (P < .01) after surgery. CONCLUSION High circulating DBP concentrations are associated with better mobility and reduced mortality after hip fracture surgery. The role of DBP as an acute phase reactant to tissue injury and clinical outcomes should be addressed in future study.
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Affiliation(s)
- Lingqiong Meng
- Department of Nutritional Sciences, and the Institute of Food, Nutrition & Health, Rutgers University, New Brunswick, NJ 08901, USA
| | - Xiangbing Wang
- Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Jeffrey L Carson
- Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Yvette Schlussel
- Department of Nutritional Sciences, and the Institute of Food, Nutrition & Health, Rutgers University, New Brunswick, NJ 08901, USA
| | - Sue A Shapses
- Department of Nutritional Sciences, and the Institute of Food, Nutrition & Health, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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Zhu J, Cheng X, Li Y, Bai L, Su Z. Low lymphocyte-to-C-reactive protein ratio relates to high 1-year mortality in elderly patients undergoing hemiarthroplasty for displaced femoral neck facture. J Orthop Surg Res 2022; 17:512. [PMID: 36434736 PMCID: PMC9700922 DOI: 10.1186/s13018-022-03406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Lymphocyte-to-C-reactive protein (CRP) ratio (LCR) is a novel biomarker for predicting poor prognosis in many diseases. This study aims to analyze the association between preoperative LCR and 1-year mortality in elderly patients with displaced FNF undergoing hemiarthroplasty. METHODS Between May 2017 and May 2019, a retrospective study including 364 elderly patients undergoing hemiarthroplasty for displaced FNF was performed. LCR was defined as the ratio of preoperative lymphocyte count to CRP level. The optimal cutoff value of LCR was determined by receiver operating characteristic curve, and all patients were categorized into low-LCR group and high-LCR group accordingly. The relationship between LCR and 1-year mortality was evaluated by using univariate and multivariate Cox regression analysis. Furthermore, the complications within 30 days after surgery, length of hospital stay, and perioperative red blood cell transfusion were also analyzed stratified by LCR. RESULTS A total of 47 patients (12.9%) died within 1-year follow-up after surgery. The optimal cutoff value for LCR was 30,560 (specificity 76.6% and sensitivity 63.4%). Low-LCR (≤ 30,560) group had a higher mortality rate than high-LCR group (23.53% vs. 5.21%, P < 0.001). In multivariate analysis, low LCR, hypoalbuminemia, and Age-Adjusted Charlson Comorbidity Index ≥ 6 were identified as independent predictors for 1-year mortality. Moreover, low level of LCR was associated with high rate of total complications (19.6% vs. 11.4%, P = 0.029), perioperative transfusions (37.9% vs. 27.0%, P = 0.027), and longer hospital stay (7.84 ± 2.40 vs. 7.30 ± 2.32, P = 0.031). CONCLUSIONS The low level of preoperative LCR can effectively predict 1-year mortality and 30-day total complications after surgery in elderly patients with displaced FNF undergoing hemiarthroplasty.
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Affiliation(s)
- Jian Zhu
- grid.470966.aDepartment of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032 Shanxi Province China
| | - Xiaodong Cheng
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 China
| | - Yonglong Li
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051 China
| | - Liping Bai
- grid.470966.aDepartment of Anesthesiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032 Shanxi Province China
| | - Zhongyi Su
- grid.470966.aDepartment of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032 Shanxi Province China
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Liu R, Zhang YN, Fei XJ, Wang JY, Hua RL, Tong YN, Li K, Cao WW, Chen SH, Zhang BF, Chen J, Zhang YM. Association between Neutrophil Levels on Admission and All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study of 2,589 Patients. Int J Clin Pract 2022; 2022:1174521. [PMID: 36628151 PMCID: PMC9797311 DOI: 10.1155/2022/1174521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the association between neutrophil levels and all-cause mortality in geriatric hip fractures. METHODS Elderly patients with hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between neutrophil levels and mortality. Analyses were performed using Empower Stats and R software. RESULTS A total of 2,589 patients were included in this study. The mean follow-up period was 38.95 months. During the study period, 875 (33.80%) patients died due to various causes. Linear multivariate Cox regression models showed that neutrophil levels were associated with mortality after adjusting for confounding factors, when neutrophil concentration increased by 1∗109/L, the mortality risk increased by 3% (HR = 1.03, 95% CI: 1.00-1.06, and P=0210). Neutrophil concentration was used as a categorical variable; we only found statistically significant differences when neutrophil levels were high (HR = 1.27, 95% CI:1.05-1.52, and P=0.0122). In addition, the results are stable in P for trend and propensity score matching sensitivity analysis. CONCLUSIONS Neutrophil levels are associated with mortality in geriatric hip fractures and could be considered a predictor of death risk in the long-term. This study is registered with the Chinese Clinical Trial Registry (ChiCTR) as number ChiCTR2200057323.
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Affiliation(s)
- Rui Liu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Yan-Ning Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Xu-Jing Fei
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Jing-Ya Wang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Rong-Li Hua
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Ying-Na Tong
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Kun Li
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Wen-Wen Cao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Shao-Hua Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Juan Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
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Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr 2021; 21:155. [PMID: 33663402 PMCID: PMC7934427 DOI: 10.1186/s12877-021-02102-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/22/2021] [Indexed: 01/01/2023] Open
Abstract
Background The systemic immune-inflammation index (SII), based on peripheral platelet, neutrophil and lymphocyte counts, has been proven to be a promising prognostic indicator in various diseases. Hip fracture is a common injury among the older adults, and has become a global public health problem with high mortality and disability rates. However, the relationship between SII and the prognosis of hip fracture is not yet well-known. The aim of the this study was to explore the predictive value of SII in older adults with hip fracture undergoing surgery. Methods This was a prospective cohort study performed from January 2014 to December 2018 at a orthopaedic center, China. The SII was calculated as platelet×neutrophil/lymphocyte counts. Univariable and multivariable Cox proportional hazard models were used to assess the association between SII and all-cause mortality. Results A total of 290 older adults with hip fracture were included, and the mean (SD) age was 77.6 (8.6) years, and 189 (65.2%) were female. The median (IQR) SII was 759.4 (519.0–1128.7) × 109/L. After a median follow-up time of 33.4 months, 13 (4.5%), 26 (9.0%) and 54 (18.6%) patients died within the 30-day, 1-year and last follow-up, respectively. Multivariable Cox analysis revealed that each increase of 100 units of SII was associated with a 8% increased hazard of death at 1-year follow-up (HR = 1.08, 95% CI: 1.01–1.17, p = 0.033), and 9% increased hazard of death at last follow-up (HR = 1.09, 95% CI: 1.03–1.15, p = 0.003). Conclusions SII is associated with poor all-cause mortality in older adults with hip fracture undergoing surgery, and deserves further investigation and application in clinical practice.
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Affiliation(s)
- Zhi-Cong Wang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Wei Jiang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Xi Chen
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Ling Yang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Hong Wang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Yue-Hong Liu
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China.
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