Comparison of Prognostic Value of 10 Biochemical Indices at Admission for Prediction Postoperative Myocardial Injury and Hospital Mortality in Patients with Osteoporotic Hip Fracture

Aim: To evaluate the prognostic impact at admission of 10 biochemical indices for prediction postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In 1273 consecutive patients with HF (mean age 82.9 +/- 8.7 years, 73.5% women), clinical and laboratory parameters were collected prospectively, and outcomes were recorded. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were preformed, the number needed to predict (NNP) outcome was calculated. Results: Age >= 80 years and IHD were the most prominent clinical factors associated with both PMI (with cardiac troponin I rise) and in-hospital death. PMI occurred in 555 (43.6%) patients and contributed to 80.3% (49/61) of all deaths (mortality rate 8.8% vs. 1.9% in non-PMI patients). The most accurate biochemical predictive markers were parathyroid hormone > 6.8 pmol/L, urea > 7.5 mmol/L, 25(OH)vitamin D < 25 nmol/L, albumin < 33 g/L, and ratios gamma-glutamyl transferase (GGT) to alanine aminotransferase > 2.5, urea/albumin >= 2.0 and GGT/albumin >= 7.0; the AUC for developing PMI ranged between 0.782 and 0.742 (NNP: 1.84-2.13), the AUC for fatal outcome ranged from 0.803 to 0.722, (NNP: 3.77-9.52). Conclusions: In HF patients, easily accessible biochemical indices at admission substantially improve prediction of hospital outcomes, especially in the aged >80 years with IHD.

Automated summary

This study aimed to evaluate the impact of 10 biochemical indices on predicting postoperative myocardial injury (PMI) and/or hospital death in hip fracture patients. The results showed that age ≥80 years and ischemic heart disease were the most prominent factors associated with both PMI and in-hospital death. Several biochemical markers were identified as accurate predictors, including parathyroid hormone, urea, 25(OH)vitamin D, albumin, and various ratios. These easily accessible biochemical indices substantially improved the prediction of hospital outcomes in hip fracture patients, especially in elderly patients over 80 years old with ischemic heart disease.