Early and subacute inflammatory response and long-term survival after hip trauma and surgery

Abstract

Background: Hip fractures represent major source of morbidity in elderly patients. There is little evidence about the impact of inflammatory changes induced by hip trauma and surgery on long term survival.

Methods: We evaluated the prognostic significance of the surgery-related dynamics of white blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6) and soluble adhesion molecules (including P-selectin, E-selectin and VCAM) on survival in 104 consecutive patients with traumatic hip fractures recruited within the 2 years period.

Results: In surviving patients, the minimum follow-up length was 48 and maximum 84 months (median 60 months). The mean age of the population was 80 ± 9 years, 72% were women. The survival rates were 69%, 45% and 38% at one, three and five years of the follow-up, respectively. Baseline serum creatinine, older age and subdural anesthesia type were associated with worse survival. The acute inflammatory response failed to predict the long term survival. In contrast, elevated WBC and IL-6 as assessed 21 days after the surgery were associated with a significantly worse outcome.

Conclusion: The survival of elderly patients undergoing the surgery for acute hip fracture is unfavorable. In contrast to previous reports, we did not confirm that acute inflammatory response to the surgery predicts the long-term survival. On the contrary, persistent elevation of WBC and IL-6 three weeks after the surgery indicates a poor outcome.

Keywords: Hip fracture; Inflammation; Interleukin-6; Mortality; Prognosis.