Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial

Abstract

Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): -0.54; 95% CI: -1.08--0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00-3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: -1.10; 95% CI: -2.33-0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality.

Keywords: elderly patients; oxidative stress; surgery; taurine supplementation.

Figure 1

Flow Chart Inclusion. Kidney function is defined as creatinine clearance calculated with the Cockroft-Gault formula; miscellaneous patients: Three gastro-intestinal passage disorder, three language barrier, one hearing disability, thirteen secondary fractures, two had surgery in other hospital, eight cancer ± metastases, five primary total hip arthroplasty, six already participating in current study trial with contra lateral hip, three planned transfer to other hospital directly after surgery, one participating in other study trial.

Figure 2

Kaplan Meier curve for mortality; 365 days after surgery. Intention to treat analysis; Log-rank = 0.75.

Figure A1

Results of a dose finding on taurine dosage.