Biomarkers as predictors of inpatient mortality in fractured neck of femur patients.

Introduction: Hip fractures are common and it is estimated to cost the National Health Service (NHS) around £2 billion/year. The majority of these patients are elderly and they require careful perioperative management as morbidity and mortality are high. This study aims to look at routinely gathered biomarker data and baseline demographics to evaluate if they may be used to predict inpatient mortality.

Patients And Methods: The study included 2158 patients from a single Centre over a 5-year period.

Inclusion Criteria: age>60, confirmed fractured neck of femur on radiological imaging.

Exclusion Criteria: pathological fractures, patients treated non-operatively, missing data. Univariate followed by multivariate analysis was conducted to identify the independent predictors of inpatient mortality.

Results: The variables found to be independent predictors of inpatient mortality were: age > 85, sex (male), albumin < 35, lymphocytes < 1, American Society of Anesthesiologist (ASA) grade > 3. For the final derived multivariate logistic regression model, a receiver operator characteristic (ROC) curve was constructed to assess the ability of the included variables to predict inpatient mortality. The area under the curve was 0.794 which together with sensitivity of 63.2% and a specificity of 79.1% at a cut value of 0.1.

Conclusion: This paper supports research previously conducted in this field, showing the prognostic value of both biomarker (albumin and lymphocytes), and non-biomarker data (ASA grade, age and gender) in predicting mortality in patients who have sustained a hip fracture.