title: Prognostic Value of Serum Procalcitonin After Orthopedic Surgery in the Elderly Population.
abstract: Orthopedic surgery is more and more frequent in the older patients and is associated with a high mortality rate. Although serum procalcitonin levels are associated with prognosis in young adults, data are still lacking in the elderly population, and especially after surgery. The main objective of this study was to determine the prognostic value of procalcitonin levels in a large geriatric orthopedic population, and we compared it with clinical variables and biomarkers.
  
  
  
  This is a prospective study including patients admitted in our dedicated geriatric postoperative unit, after orthopedic surgery with immediate postoperative measured procalcitonin levels. Collected data included age, sex, medical history, functional status (activities of daily living [ADL]), fracture type, Cumulative Illness Rating scale (CIRS), postoperative complications, and biological data. The primary endpoint was the 30-day mortality.
  
  
  
  436 patients (age 85±6 years) were included. Hip fracture surgery was the most frequent (n = 310; 71%), and the 30-day mortality rate was 6.9%. Compared with C-reactive protein (CRP), albumin, CIRS, and ADL, procalcitonin had the highest area under the receiver operating characteristic curve for predicting 30-day mortality (0.74; 95% CI: 0.70-0.78). Using a cutoff at 1 µg/L, procalcitonin was more specific than CIRS to predict 30-day mortality (92 vs 77%; p < .001). In a multivariable analysis, procalcitonin level higher than 0.39 µg/L is a significant predictor of mortality within 30 days (odds ratio 3.84; 95% CI: 1.61-9.14, p = .002).
  
  
  
  Elevated procalcitonin values were strongly and significantly associated with mortality within 30 days in older patients after orthopedic surgery.
authors.affiliation: Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.|Sorbonne Universités, UPMC Paris 6, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Vallet
authors.affiliation: Clinical Chemistry Laboratory, Hôpitaux Universitaires Paris Centre (HUPC), APHP, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.affiliation: Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Villain
authors.affiliation: Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.
authors.forename: Judith
authors.initials: J
authors.lastname: Cohen-Bittan
authors.affiliation: Sorbonne Universités, UPMC Paris 6, Paris, France.|Department of Emergency Medicine, Groupe Hospitalo-Universitaire de l'Est parisien, site Tenon, APHP, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
authors.affiliation: Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Université de la Guyane, Institut Pasteur de La Guyane et Centre d'Investigation Clinique CIC Antilles-Guyane Inserm 1424, Guyane Française, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Epelboin
authors.affiliation: Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.|Sorbonne Universités, UPMC Paris 6, Paris, France.|UMR CNRS 8256, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Verny
authors.affiliation: Sorbonne Universités, UPMC Paris 6, Paris, France.|Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France.|UMR INSERM 1166, IHU ICAN, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.affiliation: Sorbonne Universités, UPMC Paris 6, Paris, France.|Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Khiami
authors.affiliation: Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.|Sorbonne Universités, UPMC Paris 6, Paris, France.|UMR CNRS 8256, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Boddaert
mesh_terms: D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D002116:Calcitonin
keywords: Biomarkers; Elderly Population; Hip fracture; Procalcitonin; Prognosis