Correlation between C-reactive protein and postoperative mortality in patients undergoing hip fracture surgery: a meta-analysis

Journal of Orthopaedic Surgery and Research - Tập 18 - Trang 1-9 - 2023
Bing-Kuan Chen1, Yu-Cheng Liu2, Chun-Ching Chen2, Yu-Pin Chen3,4, Yi-Jie Kuo3,4, Shu-Wei Huang3
1Department of General Medicine, Shuang Ho Hospital, New Taipei City, Taiwan
2College of Medicine, Taipei Medical University, Taipei, Taiwan
3Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
4Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Tóm tắt

Hip fracture is a common but devastating disease with a high mortality rate in the older adult population. C-reactive protein (CRP) is a predictor of the prognosis in many diseases, but its correlations with patient outcomes following hip fracture surgery remain unclear. In this meta-analysis, we investigated the correlation between perioperative CRP level and postoperative mortality in patients undergoing hip fracture surgery. PubMed, Embase, and Scopus were searched for relevant studies published before September 2022. Observational studies investigating the correlation between perioperative CRP level and postoperative mortality in patients with hip fracture were included. The differences in CRP levels between the survivors and nonsurvivors following hip fracture surgery were measured with mean differences (MDs) and 95% confidence intervals (CIs). Fourteen prospective and retrospective cohort studies comprising 3986 patients with hip fracture were included in the meta-analysis. Both the preoperative and postoperative CRP levels were significantly higher in the death group than in the survival group when the follow-up duration was ≥ 6 months (MD: 0.67, 95% CI: 0.37–0.98, P < 0.0001; MD: 1.26, 95% CI: 0.87–1.65, P < 0.00001, respectively). Preoperative CRP levels were significantly higher in the death group than in the survival group when the follow-up duration was ≤ 30 days (MD: 1.49, 95% CI: 0.29–2.68; P = 0.01). Both higher preoperative and postoperative CRP levels were correlated with higher risk of mortality following hip fracture surgery, suggesting the prognostic role of CRP. Further studies are warranted to confirm the ability of CRP to predict postoperative mortality in patients with hip fracture.

Tài liệu tham khảo

Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18(1 Suppl):57S-63S. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285–9. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407–13. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458–60. Maffulli N, Aicale R. Proximal femoral fractures in the elderly: a few things to know, and some to forget. Medicina (Kaunas). 2022;58(10):1314. Migliorini F, Maffulli N, Trivellas M, Eschweiler J, Hildebrand F, Betsch M. Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis. Eur J Trauma Emerg Surg. 2022;48(4):2655–66. Chen YP, Kuo YJ, Liu CH, Chien PC, Chang WC, Lin CY, et al. Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study. Ther Adv Musculoskelet Dis. 2021;13:1759720X211028360. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20(10):1633–50. Chiang MH, Huang YY, Kuo YJ, Huang SW, Jang YC, Chu FL, et al. Prognostic factors for mortality, activity of daily living, and quality of life in taiwanese older patients within 1 year following hip fracture surgery. J Pers Med. 2022;12(1):102. Rose S, Maffulli N. Hip fractures. An epidemiological review. Bull Hosp Jt Dis. 1999;58(4):197–201. Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43(6):676–85. Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019;20(1):568. Chen YH, Chou CH, Su HH, Tsai YT, Chiang MH, Kuo YJ, et al. Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis. J Orthop Surg Res. 2021;16(1):681. Sun T, Wang X, Liu Z, Chen X, Zhang J. Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients. Injury. 2011;42(7):707–13. Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021;21(1):155. Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci. 2011;48(4):155–70. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020;127: 104370. Ekinci M, Bayram S, Gunen E, Col KA, Yildirim AM, Yilmaz M. C-reactive protein level, admission to intensive care unit, and high american society of anesthesiologists score affect early and late postoperative mortality in geriatric patients with hip fracture. Hip Pelvis. 2021;33(4):200–10. Kim BG, Lee YK, Park HP, Sohn HM, Oh AY, Jeon YT, et al. C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery: a retrospective analysis. Medicine (Baltimore). 2016;95(43): e5152. Menéndez-Colino R, Alarcon T, Gotor P, Queipo R, Ramírez-Martín R, Otero A, et al. Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA Cohort). Injury. 2018;49(3):656–61. Niessen R, Bihin B, Gourdin M, Yombi JC, Cornu O, Forget P. Prediction of postoperative mortality in elderly patient with hip fractures: a single-centre, retrospective cohort study. BMC Anesthesiol. 2018;18(1):183. Sedlář M, Kvasnička J, Krška Z, Tománková T, Linhart A. Early and subacute inflammatory response and long-term survival after hip trauma and surgery. Arch Gerontol Geriatr. 2015;60(3):431–6. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):1785–805. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. Thorlund K, Imberger G, Johnston BC, et al. Evolution of heterogeneity (I2) estimates and their 95% confidence intervals in large meta-analyses. PLoS ONE. 2012;7(7): e39471. Azevedo PS, Gumieiro DN, Polegato BF, Pereira GJ, Silva IA, Pio SM, et al. Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture. BMC Musculoskelet Disord. 2017;18(1):134. Bae SJ, Lee SH. Computed tomographic measurements of the psoas muscle as a predictor of mortality in hip fracture patients: Muscle attenuation helps predict mortality in hip fracture patients. Injury. 2021;52(6):1456–61. Balta O, Altınayak H, Gürler Balta M, Astan S, Uçar C, Kurnaz R, et al. Can C-reactive protein-based biomarkers be used as predictive of 30-day mortality in elderly hip fractures?A retrospective study. Ulus Travma Acil Cerrahi Derg. 2022;28(6):849–56. Capkin S, Guler S, Ozmanevra R. C-reactive protein to albumin ratio may predict mortality for elderly population who undergo hemiarthroplasty due to hip fracture. J Invest Surg. 2021;34(11):1272–7. Choi SU, Rho JH, Choi YJ, Jun SW, Shin YJ, Lee YS, et al. Postoperative hypoalbuminemia is an independent predictor of 1-year mortality after surgery for geriatric intertrochanteric femoral fracture: a retrospective cohort study. Medicine (Baltimore). 2021;100(51): e28306. Çiçek V, Cinar T, Hayiroglu MI, Kılıç Ş, Keser N, Uzun M, et al. Preoperative cardiac risk factors associated with in-hospital mortality in elderly patients without heart failure undergoing hip fracture surgery: a single-centre study. Postgrad Med J. 2021;97(1153):701–5. Gulin T, Kruljac I, Kirigin L, Merc M, Pavić M, Trcin MT, et al. Advanced age, high β-CTX levels, and impaired renal function are independent risk factors for all-cause one-year mortality in hip fracture patients. Calcif Tissue Int. 2016;98(1):67–75. Gumieiro DN, Rafacho BP, Gonçalves AF, Santos PP, Azevedo PS, Zornoff LA, et al. Serum metalloproteinases 2 and 9 as predictors of gait status, pressure ulcer and mortality after hip fracture. PLoS ONE. 2013;8(2): e57424. McLeod G, Kennedy I, Simpson E, Joss J, Goldmann K. Pilot project for a web-based dynamic nomogram to predict survival 1 year after hip fracture surgery: retrospective observational study. Interact J Med Res. 2022;11(1): e34096. Zhou J, Fu J, Zhao Q, Lin S, Zhu H. Effect of neutrophil-to-lymphocyte ratio on short-term prognosis of elderly patients with hip fracture. Am J Transl Res. 2021;13(8):9122–8. Bastian O, Pillay J, Alblas J, Leenen L, Koenderman L, Blokhuis T. Systemic inflammation and fracture healing. J Leukoc Biol. 2011;89(5):669–73. Amor S, Puentes F, Baker D, van der Valk P. Inflammation in neurodegenerative diseases. Immunology. 2010;129(2):154–69. Golia E, Limongelli G, Natale F, Fimiani F, Maddaloni V, Pariggiano I, et al. Inflammation and cardiovascular disease: from pathogenesis to therapeutic target. Curr Atheroscler Rep. 2014;16(9):435. Ferrucci L, Fabbri E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol. 2018;15(9):505–22. Chung HY, Kim DH, Lee EK, Chung KW, Chung S, Lee B, et al. Redefining chronic inflammation in aging and age-related diseases: proposal of the senoinflammation concept. Aging Dis. 2019;10(2):367–82. Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA, et al. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018;10(5):555. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17(6):432–7. Li S, Zhang J, Zheng H, Wang X, Liu Z, Sun T. Prognostic role of serum albumin, total lymphocyte count, and mini nutritional assessment on outcomes after geriatric hip fracture surgery: a meta-analysis and systematic review. J Arthroplasty. 2019;34(6):1287–96. Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021;184:857–62. Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ. Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J. 2015;97-B(2):246–51. von Friesendorff M, McGuigan FE, Wizert A, Rogmark C, Holmberg AH, Woolf AD, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int. 2016;27(10):2945–53. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score [published correction appears in JAMA. 2007 Apr 4;297(13):1433]. JAMA. 2007;297(6):611–9. Ridker PM, Cook N. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham Risk Scores. Circulation. 2004;109(16):1955–9. Lagrand WK, Visser CA, Hermens WT, Niessen HW, Verheugt FW, Wolbink GJ, et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation. 1999;100(1):96–102. Li JJ, Fang CH. C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses. 2004;62(4):499–506. Badimon L, Peña E, Arderiu G, Padró T, Slevin M, Vilahur G, et al. C-reactive protein in atherothrombosis and angiogenesis. Front Immunol. 2018;9:430. Klestil T, Röder C, Stotter C, Winkler B, Nehrer S, Lutz M, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep. 2018;8(1):13933.