Abstract
Background:There are unmet needs in objective prognostic indicators for Hip Fracture (HF) outcomes.Objectives:To evaluate the determinants and prognostic impact of elevated serum urea, a key factor of nitrogen homeostasis, in predicting hospital mortality, inflammatory complications and length of stay in HF patients.Methods:In 1819 patients (mean age 82.8±8.1 years; 76.4% women) with osteoporotic HF, serum urea level at admission along with 22 clinical and 35 laboratory variables were analysed and outcomes recorded. The results were validated in a cohort of 455 HF patients (age 82.1±8.0 years, 72.1% women).Results:Elevated serum urea levels (>7.5mmol/L) at admission were prevalent (44%), independently determined by chronic kidney disease, history of myocardial infarction, anaemia, hyperparathyroidism, advanced age and male gender, and significantly associated with higher mortality (9.4% vs. 3.3%, p<0.001), developing a high postoperative inflammatory response (HPIR, 22.1% vs.12.1%, p=0.009) and prolonged hospital stay (>20 days: 31.2% vs. 26.2%, p=0.021). The predictive value of urea was superior to other risk factors, most of which lost their discriminative ability when urea levels were normal. Patients with two abnormal parameters at admission, compared to subjects with the normal ones, had 3.6-5.6 -fold higher risk for hospital mortality, 2.7-7.8-fold increase in risk for HPIR and 1.3-1.7-fold higher risk for prolonged hospital stay. Patients with increased admission urea and a high inflammatory response had 9.7 times greater mortality odds compared to patients without such characteristics.Conclusion:In hip fracture patients admission serum urea is an independent and valuable predictor of hospital outcomes, in particular, mortality.
Highlights
In the last two decades, serum urea concentration, the terminal product of protein metabolism, received much1874-3250/18 2018 Bentham OpenSerum Urea at Admission and Hip Fracture OutcomesThe Open Orthopaedics Journal, 2018, Volume 12 537 attention as a simple and reliable biochemical parameter for predicting adverse outcomes, especially short- and longterm mortality, in various medical and surgical settings including cardiovascular, cerebrovascular, respiratory, liver, pancreatic, septic and critically ill patients [1 - 11]
Patients with increased admission urea and a high inflammatory response had 9.7 times greater mortality odds compared to patients without such characteristics
In each patient, fasting venous blood samples were collected on admission and the following assays performed: urea and electrolytes, complete blood count, C-Reactive Protein (CRP), liver (Alanine aminotransferase [alanine aminotransferase (ALT)], GammaGlutamyl Transferase [gamma-glutamyl transferase (GGT)], alkaline phosphatase [ALP], bilirubin and albumin) and thyroid function tests, 25 (OH) vitamin D [(25(OH)D], intact parathyroid hormone (PTH) and indices of iron metabolism using standard methods and commercially available kits as we described previously [20]
Summary
In the last two decades, serum urea concentration, the terminal product of protein metabolism, received much1874-3250/18 2018 Bentham OpenSerum Urea at Admission and Hip Fracture OutcomesThe Open Orthopaedics Journal, 2018, Volume 12 537 attention as a simple and reliable biochemical parameter for predicting adverse outcomes, especially short- and longterm mortality, in various medical and surgical settings including cardiovascular, cerebrovascular, respiratory, liver, pancreatic, septic and critically ill patients [1 - 11]. Serum Urea at Admission and Hip Fracture Outcomes. Liver is the main ureagenic organ and routine hepatocyte function parameters (albumin levels, enzyme activities) have been found to be valuable prognostic indicators for poor outcomes in HF patients [19 - 22], no study was performed on the relationship between serum urea, liver function characteristics at admission and outcomes in HF. The aims of this study were to assess in a representative sample of older HF patients [1] the prevalence and determinants of elevated serum urea level at admission, [2] its association with short-term outcomes, and [3] the potential prognostic impact alone and in combination with clinical and other biochemical characteristics, focussing on liver-specific and protein metabolism-related variables. There are unmet needs in objective prognostic indicators for Hip Fracture (HF) outcomes.
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