PDF(Pubmed)
Abstract：
UNASSIGNED: Hip fractures in frail patients result in excess mortality not accounted for by age or comorbidities. The mechanisms behind the high risk of mortality remain undetermined but are hypothesized to be related to the inflammatory status of frail patients.
UNASSIGNED: In a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI). After correcting for multiple testing, adjustments for comorbidities and demographics were performed on the statistically significant markers.
UNASSIGNED: Of the 92 markers tested, circulating levels of fibroblast growth factor 23 (FGF-23) and interleukin-15 receptor alpha (IL15RA), both involved in renal disease, were significantly correlated with 6-month mortality (27.5% overall) after correcting for multiple testing. The incidence of postoperative AKI (25.4%) was strongly associated with 6-month mortality, odds ratio = 10.57; 95% CI [2.76-40.51], and with both markers plus estimated glomerular filtration rate (eGFR)- cystatin C (CYSC) but not eGFR-CRE. The effect of these markers on mortality was significantly mediated by their effect on postoperative AKI.
UNASSIGNED: High postoperative mortality in frail hip fracture patients is highly correlated with preoperative biomarkers of renal function in this pilot study. The effect of preoperative circulating levels of FGF-23, IL15RA, and eGFR-CYSC on 6-month mortality is in part mediated by their effect on postoperative AKI. Creatinine-derived preoperative renal function measures were very poorly correlated with postoperative outcomes in this group.
UNASSIGNED: In a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI). After correcting for multiple testing, adjustments for comorbidities and demographics were performed on the statistically significant markers.
UNASSIGNED: Of the 92 markers tested, circulating levels of fibroblast growth factor 23 (FGF-23) and interleukin-15 receptor alpha (IL15RA), both involved in renal disease, were significantly correlated with 6-month mortality (27.5% overall) after correcting for multiple testing. The incidence of postoperative AKI (25.4%) was strongly associated with 6-month mortality, odds ratio = 10.57; 95% CI [2.76-40.51], and with both markers plus estimated glomerular filtration rate (eGFR)- cystatin C (CYSC) but not eGFR-CRE. The effect of these markers on mortality was significantly mediated by their effect on postoperative AKI.
UNASSIGNED: High postoperative mortality in frail hip fracture patients is highly correlated with preoperative biomarkers of renal function in this pilot study. The effect of preoperative circulating levels of FGF-23, IL15RA, and eGFR-CYSC on 6-month mortality is in part mediated by their effect on postoperative AKI. Creatinine-derived preoperative renal function measures were very poorly correlated with postoperative outcomes in this group.
摘要：
■虚弱患者的髋部骨折导致死亡率过高，而不是年龄或合并症。高死亡风险背后的机制仍未确定，但假设与虚弱患者的炎症状态有关。
■在一项针对住院的脆弱髋部骨折患者的前瞻性观察性探索性队列研究中，在术前血清样品中测试了92种炎性标志物，并针对髋部骨折手术后6个月的生存率和急性肾损伤（AKI）的发生率测试了标志物。校正多次测试后，对有统计学意义的标志物进行了合并症和人口统计学调整.
■在测试的92个标记物中，成纤维细胞生长因子23（FGF-23）和白细胞介素15受体α（IL15RA）的循环水平，两者都与肾脏疾病有关，校正多重检验后,与6个月死亡率(总体为27.5%)显著相关.术后AKI发生率（25.4%）与6个月死亡率密切相关。比值比=10.57；95%CI[2.76-40.51]，两种标记物加上估计的肾小球滤过率（eGFR）-胱抑素C（CYSC），而不是eGFR-CRE。这些标志物对死亡率的影响显著地由它们对术后AKI的影响介导。
■在这项初步研究中，髋部骨折患者术后高死亡率与术前肾功能生物标志物高度相关。术前循环FGF-23，IL15RA水平的影响，eGFR-CYSC对6个月死亡率的影响部分由其对术后AKI的影响介导。在该组中，源自肌酐的术前肾功能指标与术后结局的相关性非常差。
■在一项针对住院的脆弱髋部骨折患者的前瞻性观察性探索性队列研究中，在术前血清样品中测试了92种炎性标志物，并针对髋部骨折手术后6个月的生存率和急性肾损伤（AKI）的发生率测试了标志物。校正多次测试后，对有统计学意义的标志物进行了合并症和人口统计学调整.
■在测试的92个标记物中，成纤维细胞生长因子23（FGF-23）和白细胞介素15受体α（IL15RA）的循环水平，两者都与肾脏疾病有关，校正多重检验后,与6个月死亡率(总体为27.5%)显著相关.术后AKI发生率（25.4%）与6个月死亡率密切相关。比值比=10.57；95%CI[2.76-40.51]，两种标记物加上估计的肾小球滤过率（eGFR）-胱抑素C（CYSC），而不是eGFR-CRE。这些标志物对死亡率的影响显著地由它们对术后AKI的影响介导。
■在这项初步研究中，髋部骨折患者术后高死亡率与术前肾功能生物标志物高度相关。术前循环FGF-23，IL15RA水平的影响，eGFR-CYSC对6个月死亡率的影响部分由其对术后AKI的影响介导。在该组中，源自肌酐的术前肾功能指标与术后结局的相关性非常差。
