Different C-reactive protein kinetics in post-operative hip-fractured geriatric patients with and without complications.
BACKGROUND
Hip fracture is a frequent injury in the elderly, and is associated with a high incidence of functional impairment, complications and mortality.


OBJECTIVE
To determine kinetics of C-reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate (ESR) in hip-fractured patients over a 1-month post-operative period; to examine the relationship of these parameters to cognition, operation type, post-operational complications, functional level 1 month post-operatively and 6-month mortality.


METHODS
32 aged patients operated on for hip fracture were prospectively followed-up for 6 months. Fracture, type of operation and anesthetic risk were recorded. Cognition was evaluated by the Mini-Mental State Examination and pre-fracture functional level evaluated by the Katz Index of ADL. Follow-up included complications, mortality and functional outcome. CRP, fibrinogen and ESR were assessed during the first 10 h post-fracture; 48-60 h, and 7 and 30 days post-operatively, respectively.


RESULTS
Only CRP kinetics were found to differ in patients with complications vs. those without, as a group (p = 0.006), and in patients suffering infections, delirium and cardiovascular complication vs. patients with no complications (p = 0.06, 0.03, 0.02, respectively). Mean (+/-SEM) CRP 48-60 h post-operatively was 20.9 +/- 2.1 and 13.1 +/- 1.6 mg/dl in complicated and uncomplicated patients, respectively (p = 0.002). The mean CRP 48-60 h post-operatively was highly correlated with the CRP area under the curve, R = 0.88 (p < 0.001). A cut-off level of 15 mg/dl for CRP, 48- 60 h post-operatively, was calculated for patients with complications (sensitivity 93%, specificity 65%, p = 0.003). CRP, fibrinogen and ESR were not related to fracture or type of operation, cognition, anesthetic risk, 1-month post-operative functioning and 6-month mortality.


CONCLUSIONS
CRP measurement in elderly patients operated for hip fracture may be valuable in assessing and monitoring complications.
Beloosesky
Yichayaou
Y
Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel. belo-7@zahav.net.il
Grinblat
Joseph
J
Pirotsky
Anatoly
A
Weiss
Avraham
A
Hendel
David
D
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood; D003071:Cognition; D003693:Delirium / Q000097:blood; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D016330:Frail Elderly; D006620:Hip Fractures / Q000097:blood* / Q000601:surgery; D006801:Humans; D007239:Infections / Q000097:blood; D008297:Male; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors
D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein