Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6)

Sedlář, Martin; Kudrnová, Zuzana; Erhart, David; Trča, S; Kvasnička, Jan; Krška, Z; Mazoch, Jiří; Malíková, Ivana; Zeman, Miroslav; Linhart, Aleš

doi:10.1016/j.archger.2009.06.006

Cited by 19 publications

(19 citation statements)

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“…Postoperative CRP is a sensitive marker for detecting postoperative complications, especially delirium, in elderly patients undergoing hip fracture surgery. [ 20 21–25 ] In agreement with previous studies, our results showed that patients with postoperative delirium had higher pre- and postoperative CRP levels than did those without. Delirium per se is associated with an increased risk of death in elderly patients with hip fractures.…”

Section: Discussionsupporting

confidence: 92%

“…Considering the time course of the CRP in elderly patients undergoing hip fracture surgery, the CRP level tends to be elevated postoperatively and peaks on the second postoperative day [21] . Postoperative CRP is a sensitive marker for detecting postoperative complications, especially delirium, in elderly patients undergoing hip fracture surgery.…”

Section: Discussionmentioning

confidence: 99%

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C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery

et al. 2016

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Numerous factors are associated with mortality after hip fracture surgery in elderly patients. The aim of this study was to investigate whether preoperative C-reactive protein (CRP) was an independent risk factor for 1-year mortality after hip fracture surgery in the elderly. The electronic medical records of 772 elderly patients (age ≥ 65 years) undergoing hip fracture surgery from May 2003 to November 2011 were reviewed retrospectively. The patients comprised a high CRP group (>10.0 mg/dL) and low CRP group (≤10.0 mg/dL), based upon preoperative CRP levels. The overall 1-year mortality was 14.1%; the value was significantly higher in the high CRP group than in the low CRP group (31.8% vs 12.5%; P < 0.001). On binary logistic regression, body mass index (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.88–0.99; P = 0.025), history of malignancy (OR, 2.59; 95% CI, 1.47–4.57; P = 0.001), American Society of Anesthesiologists physical status (ASA PS) class 3–4 (OR, 1.96; 95% CI, 1.25–3.07; P = 0.003), preoperative albumin (OR, 0.39; 95% CI, 0.25–0.61; P < 0.001), preoperative CRP > 10.0 mg/dL (OR, 2.04; 95% CI, 1.09–3.80; P = 0.025), postoperative intensive care unit (ICU) admission (OR, 2.29; 95% CI, 1.15–4.59; P = 0.019), and creatinine on the second postoperative day (OR, 1.20; 95% CI, 1.00–1.45; P = 0.048) were independent predictors of 1-year mortality after hip surgery. Male gender and low preoperative hemoglobin were associated with in-hospital mortality, whereas delayed surgery and femoral neck fracture were related to the 6-month mortality. Low preoperative albumin and low body mass index predicted the 6-month and 1-year mortality. An increased preoperative CRP level, particularly >10.0 mg/dL, was associated with the 1-year mortality after hip fracture surgery in the elderly. In addition, a history of malignancy, high ASA PS score, and postoperative ICU admission were related to mortality after hip fracture.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery

et al. 2016

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“…Only individual research projects have studied cytokines levels after trauma in the elderly, but without comparison to other age groups. In our study, however, higher levels of IL-8 on the fifth day after trauma in patients over 60 years old had a positive correlation with infectious complications [ 19 ].…”

Section: Discussionmentioning

confidence: 79%

Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries in the early period after trauma

Gołąbek-Dropiewska¹,

Pawłowska²,

Witkowski³

et al. 2018

cejoi

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IntroductionSevere trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance.The aim of the studySevere trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient’s immunological status before the decision to introduce elective procedures.Material and methodsThe study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdańsk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score – RTS, Injury Severity Score – ISS, Glasgow Coma Scale – GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1β, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury.ResultsEvaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including “timing” depending on the patient’s biological status.

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“…[2] However, acute inflammatory response during the postoperative period can be affected by different factors, such as type of surgery. Sedlár et al [13] reported that elevation of CRP, WBC, and IL-6 levels was highest in patients treated with hemiarthroplasty compared with patients treated with osteosynthesis. Del Prete et al [14] found that secretion of inflammatory markers, especially IL-6, is less marked when minimally invasive techniques are used compared with traditional surgery for the fixation of pertrochanteric fracture via dynamic hip screw.…”

Section: Discussionmentioning

confidence: 99%

Admission Neutrophile to Lymphocyte Ratio and Postoperative Mortality in Elderly Hip Fracture Patients

Temiz

Эрсозлу²

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that the neutrophil-to-lymphocyte ratio (NLR), which is a laboratory marker used to evaluate systemic inflammation, may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission NLR in elderly patients with hip fracture. METHODS: We evaluated patients admitted to the Orthopaedic Surgery Department of Balikesir-Edremit State Hospital. Inclusion criteria were female gender, age between 65 and 80 years, ASA score of 3, unstable intertrochanteric fracture treated with hemiarthroplasty, and time between fracture and surgery less than 72 h. Patients with multiple fracture, previous same side or other side hip surgery, pathological fracture, such as fracture caused by tumor or metabolic bone disease (e.g., Paget's disease), and malignancies were excluded from this study (purposive sampling technique). Finally, "case" (group 1) was defined as patients who died within 1 year after surgery, whereas "control" (group 2) was defined as patients who survived. Patients in group 1 and 2 were statistically compared in terms of NLR value on hospital admission. A total of 22 patients (44%) were included in group 1, and 28 (56%) were included in group 2. RESULTS: We found that the admission NLR values of patients in the mortality group were significantly higher than those of patients in the control group (p<0.001). The cutoff value of NLR was calculated as 4.7 on ROC analysis. CONCLUSION: We believe that the NLR value at admission could be used for risk stratification of mortality in elderly patients with hip fracture.

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Older age and type of surgery predict the early inflammatory response to hip trauma mediated by interleukin-6 (IL-6)

Cited by 19 publications

References 18 publications

C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery

C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery

Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries in the early period after trauma

Admission Neutrophile to Lymphocyte Ratio and Postoperative Mortality in Elderly Hip Fracture Patients

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