Lactate dehydrogenase (LDH) and C-reactive protein (CRP) as a potential prognostic factor in metastatic bone disease (MBD) of proximal femur based on Harris hip score (HHS) underwent cephalomedullary nailing and bipolar hemiarthroplasty

Abstract

Introduction: Pathological fractures in the proximal femur are common, often caused by metastatic bone disease (MBD). Treatment options include resection, reconstruction, or fixation. This study explores the prognostic value of C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels in the Harris Hip Score (HHS) for patients with pathological fractures due to MBD. Methods: Forty patients with pathological fractures were divided into cephalomedullary nail (CM) and bipolar hemiarthroplasty (BHA) groups. CRP and LDH levels were measured. The correlation between CRP, LDH, and HHS was assessed using Pearson's and Spearman's correlation. Multiple linear regression was used to predict HHS from CRP and LDH. Results: The mean age of patients was 59 years, with 95% having poor HHS. CRP and LDH levels were significantly correlated with HHS (CRP: r = -0.47, p = 0.002; LDH: r = 0.59, p <0.001). Multiple linear regression showed CRP and LDH as predictors of HHS (R² = 0.36, p < 0.001), with the fitted model: "HHS = 95.76 - 0.317*(CRP) - 0.232*(LDH)". Elevated CRP and LDH levels indicate ongoing inflammation and cellular stress, potentially hindering recovery and impacting HHS. CRP's association with adverse prognoses in various cancers is highlighted. LDH's role in cellular stress and metabolism is emphasized. Combining CRP and LDH evaluations enhances the prognostic assessment of MBD and HHS outcomes. Conclusion: CRP and LDH levels significantly correlate with HHS in patients with MBD-related pathological fractures. Higher levels of CRP and LDH indicate worse functional outcomes. Evaluating these biomarkers aids in assessing disease severity and treatment effectiveness, assisting in informed clinical decisions. This study sheds light on the prognostic potential of CRP and LDH in the context of metastatic bone disease and its impact on hip function and recovery.