title: Liver function parameters in hip fracture patients: relations to age, adipokines, comorbidities and outcomes.
abstract: OBJECTIVE
  To asses liver markers in older patients with hip fracture (HF) in relation to age, comorbidities, metabolic characteristics and short-term outcomes.
  
  
  METHODS
  In 294 patients with HF (mean age 82.0±7.9 years, 72.1% women) serum alanine aminotransferase (ALT), gammaglutamyltransferase (GGT), alkaline phosphatase (ALP), albumin, bilirubin, 25(OH)vitaminD, PTH, calcium, phosphate, magnesium, adiponectin, leptin, resistin, thyroid function and cardiac troponin I were measured.
  
  
  RESULTS
  Elevated ALT, GGT, ALP or bilirubin levels on admission were observed in 1.7%-9.9% of patients. With age GGT, ALT and leptin decrease, while PTH and adiponectin concentrations increase. Higher GGT (>30 U/L, median level) was associated with coronary artery disease (CAD), diabetes mellitus (DM), and alcohol overuse; lower ALT (≤20 U/L, median level) with dementia; total bilirubin>20 μmol/L with CAD and alcohol overuse; and albumin>33 g/L with CAD. Multivariate adjusted regression analyses revealed ALT, ALP, adiponectin, alcohol overuse and DM as independent and significant determinants of GGT (as continuous or categorical variable); GGT for each other liver marker; and PTH for adiponectin. The risk of prolonged hospital stay (>20 days) was about two times higher in patients with GGT>30 U/L or adiponectin>17.14 ng/L (median level) and 4.7 times higher if both conditions coexisted. The risk of in-hospital death was 3 times higher if albumin was <33 g/L.
  
  
  CONCLUSIONS
  In older HF patients liver markers even within the normal range are associated with age-related disorders and outcomes. Adiponectin (but not 25(OH)vitaminD, PTH, leptin or resistin) is an independent contributor to higher GGT. Serum GGT and albumin predict prolonged hospital stay and in-hospital death, respectively. A unifying hypothesis of the findings presented.
authors.affiliation: 1. Department of Gastroenterology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Fisher
authors.affiliation: 2. Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Wichat
authors.initials: W
authors.lastname: Srikusalanukul
authors.affiliation: 2. Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia ; 4. Australian National University Medical School, Canberra, ACT, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fisher
authors.affiliation: 3. Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, ACT, Australia ; 4. Australian National University Medical School, Canberra, ACT, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Smith
mesh_terms: D054392:Adipokines / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism; D001663:Bilirubin / Q000097:blood; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000502:physiology*; D008111:Liver Function Tests; D008297:Male; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D054392:Adipokines; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: adipokines; comorbidities; hip fracture; liver function; outcomes