Prognostic value of cardiac troponins in elderly patients with hip fracture--a systematic review

Abstract

Cardiac troponins can be elevated in cardiac ischemic conditions or other diseases such as pulmonary embolism or renal failure, where they may predict outcome. We hypothesized that cardiac troponins offer useful prognostic information regarding morbidity and mortality in elderly hip fracture patients undergoing surgical therapy. A literature review was conducted using PubMed and CINAHL plus with full text (EBSCOhost). Articles with original data relating troponins to prognosis in elderly hip fracture patients were reviewed. Studies with patients not undergoing surgery or undergoing elective or nonhip fracture surgery were excluded. Six papers met inclusion criteria. Troponin elevation was seen in 26.7-39% of patients, while myocardial infarction, cardiac complications, and cardiac death occurred in ≤35% troponin-positive patients in four of six studies. Several noncardiac factors were associated with elevated troponin including higher American Society of Anaesthesiologists score, current smoking, reduced mobility/activity level, lower hemoglobin, and living in residential care. Patients with elevated troponin had longer lengths of stay, increased risk for discharge to long-term care facilities, and higher mortality. Increased age, male sex, and higher American Society of Anaesthesiologists score were also associated with mortality. Elevated troponin can be used as a marker of increased morbidity/mortality in elderly hip fracture patients undergoing surgery, as hypothesized, even in the absence of cardiac complications. Perioperative troponin evaluation may be useful for risk stratification, but further studies are needed to clarify risks and benefits of such testing.