Fisher A, et al. - Among older hip fracture (HF) patients, researchers examined the relationships between a broad set of routine laboratory parameters at admission and in-hospital mortality. They also evaluated the prognostic value the biomarkers and clinical characteristics (alone or in combination) provide to predict a fatal outcome. They realized that seven easily identifiable at admission characteristics, including 4 biomarkers, were strong and independent indicators of in-hospital mortality and could be utilized for risk stratification and individualized management.

Methods

• Researchers analyzed 35 laboratory variables along with 20 clinical and socio-demographic characteristics at admission among 1,820 consecutive patients with low-trauma osteoporotic HF aged >60 years (mean age 82.8 ± 8.1 years; 76.4% women; 65% community-dwelling).
• In the validation cohort, they included data on 455 older (≥60 years of age) HF patients (mean age 82.1 ± 8.0 years, 72.1% women).

Results

• The mortality rate of 6% (n = 109) was noted.
• Univariate analysis revealed that 14 laboratory and 8 clinical parameters were having association with in-hospital mortality.
• In multiple regression analyses, 7 variables at admission were identified 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).
• In subjects with any of these risk factors (RFs), the risk of in-hospital death was 1.6–2.6 times higher and the risk increased by 2.6–6.0-fold in patients with any two RFs (vs no RFs).
• A stepwise increase in the mortality rate was observed as the number of RFs increased (from 0.43% –none RF to 16.8%- ≥4RF).
• They noted that the prognostic value of a single RF was low (AUC ≤0.635) but combination of 2 or more RFs enhanced the prediction markedly; AUC reached 0.84(95%CI 0.77–0.90) when ≥4 RFs (vs 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.