Association Between High-Sensitivity Troponin T on Admission and Organ Dysfunction During Hospitalization in Patients Aged 80 Years and Older with Hip Fracture: A Single-Centered Prospective Cohort Study

Abstract

Background Prognostic evaluation of elderly patients with hip fracture is an issue that has been highly concerned by clinicians. Only a few studies have focused on organ dysfunction after hip fracture in the elderly. This study aimed to investigate the association between high-sensitivity troponin T (hs-TnT) at admission and organ dysfunction during hospitalization in elderly patients with hip fracture. Methods We enrolled 168 patients with hip fracture who were aged 80 years and older at Geriatric Orthopaedic Center of Sichuan Provincial Orthopedic Hospital between January 2020 and August 2020. Baseline characteristics, perioperative information, and short-term clinical outcomes were analyzed. Results Of the 208 patients admitted during the study period, 168 met the inclusion criteria; of these, 91 (54.2%) had higher hs-TnT than the 99th percentile in the normal population. After adjustment for confounders, elevated hs-TnT was independently associated with multiple organ dysfunction syndrome in the elderly (MODSE) (adjusted OR, 5.76; 95% CI, 1.74–19.10; P = 0.004), heart dysfunction (adjusted OR, 7.48; 95% CI, 2.17–25.82; P = 0.001), MODS severity score > 3 (adjusted OR, 5.22; 95% CI, 1.32–20.60; P = 0.018), and length of hospital stay > 14 days (adjusted OR, 2.38; 95% CI, 1.05–5.36; P = 0.037). Conclusion Increased hs-TnT on admission is an independent risk factor for MODSE after hip fracture in patients aged 80 years and older. Effective measures should be applied to avoid progression of MODSE from pre-failure stage to failure stage.

Hypotension following hip fracture surgery in patients aged 80 years or older: A prospective cohort study

“…Acute organ dysfunction in older patients is often a continuation and exacerbation on the basis of chronic degeneration or injury [ 10 ]. In this study, the HFHFS group had more chronic heart disease preoperatively, while the significant association between HFHFS and postoperative cardiac dysfunction was also confirmed by subsequent multivariate regression analysis.…”

“…Postoperative organ dysfunction referred to the changes that occurred after fracture surgery or worsened on the basis of preoperative dysfunction. Diagnostic criteria for postoperative cardiac, brain and renal dysfunction were based on Diagnostic Criteria for Multiple Organ Dysfunction Syndrome in the Elderly (MODSE) (draft, 2003) [ 10 ] ( Table 1 ). Meanwhile, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was applied for the diagnosis of delirium during hospitalization [ 11 ].…”

Metabolic Pathway of Cardiospecific Troponins: From Fundamental Aspects to Diagnostic Role (Comprehensive Review)

“…N. van der Linden et al ( van der Linden et al, 2016 ) reported that the maximum fluctuations in cardiospecific TnT concentration in a patient with CKD during the 24-h investigation period were about 50 ng/L, while the fluctuations in cardiospecific TnT levels during 1 h were about 20 ng/L, which, by the way, is a very significant contribution to the laboratory diagnosis of MI. So, for example, if we take into account modern algorithms for diagnostics of non-ST-segment elevation MI ( Table 1 ) ( Qin et al, 2021 ) (where the change in the levels of cardiospecific Tns within 1–2 h by only 5–10 ng/L is diagnostically significant), we can say that cardiospecific TnT circadian rhythms may affect the diagnostics of AMI and contribute to overdiagnosis ( van der Linden et al, 2016 ). Cardiospecific TnI levels showed slightly higher fluctuations in concentration during the day compared to the study by L. Klinkenberg et al ( Klinkenberg et al, 2016b ), however, they would not reach the thresholds of 5–10 ng/L and thus would not have a significant effect on one- and 2-h algorithms of MI diagnostics.…”

“…Besides, along with the necrosis of cardiomyocytes (CMC), there are other mechanisms of cardiospecific Tns release from CMC and/or the increase of cardiospecific Tns concentration in blood serum. Thus, several clinical studies give evidence of very frequent increase in cardiospecific Tns concentration in various pathologies ( Lindner et al, 2014 ; Saad et al, 2015 ; Wu et al, 2018 ; Askin et al, 2020 ; Qin et al, 2021 ). At the same time, the mechanism of troponin increase in these diseases is not associated with the ischemic necrosis of CMC—the main mechanism of cardiospecific Tn levels increase in MI.…”

The Importance of Cardiac Troponin Metabolism in the Laboratory Diagnosis of Myocardial Infarction (Comprehensive Review)

“…Besides, along with the necrosis of cardiomyocytes, there are other mechanisms of cardiac troponin release from myocardial cells and/or the increase in cardiac troponin concentration in blood serum. Thus, several clinical studies give evidence of very frequent increase in cardiac troponin concentration in various pathologies [ 24 – 28 ]. At the same time, the mechanism of troponin increase in these diseases is not associated with the ischemic necrosis of myocardial cells—the main mechanism of troponin levels increase in myocardial infarction.…”