Beloosesky Yichayaou, Grinblat Joseph, Pirotsky Anatoly, Weiss Avraham, Hendel David
Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.
Gerontology. 2004 Jul-Aug;50(4):216-22. doi: 10.1159/000078350.
Hip fracture is a frequent injury in the elderly, and is associated with a high incidence of functional impairment, complications and mortality.
To determine kinetics of C-reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate (ESR) in hip-fractured patients over a 1-month post-operative period; to examine the relationship of these parameters to cognition, operation type, post-operational complications, functional level 1 month post-operatively and 6-month mortality.
32 aged patients operated on for hip fracture were prospectively followed-up for 6 months. Fracture, type of operation and anesthetic risk were recorded. Cognition was evaluated by the Mini-Mental State Examination and pre-fracture functional level evaluated by the Katz Index of ADL. Follow-up included complications, mortality and functional outcome. CRP, fibrinogen and ESR were assessed during the first 10 h post-fracture; 48-60 h, and 7 and 30 days post-operatively, respectively.
Only CRP kinetics were found to differ in patients with complications vs. those without, as a group (p = 0.006), and in patients suffering infections, delirium and cardiovascular complication vs. patients with no complications (p = 0.06, 0.03, 0.02, respectively). Mean (+/-SEM) CRP 48-60 h post-operatively was 20.9 +/- 2.1 and 13.1 +/- 1.6 mg/dl in complicated and uncomplicated patients, respectively (p = 0.002). The mean CRP 48-60 h post-operatively was highly correlated with the CRP area under the curve, R = 0.88 (p < 0.001). A cut-off level of 15 mg/dl for CRP, 48- 60 h post-operatively, was calculated for patients with complications (sensitivity 93%, specificity 65%, p = 0.003). CRP, fibrinogen and ESR were not related to fracture or type of operation, cognition, anesthetic risk, 1-month post-operative functioning and 6-month mortality.
CRP measurement in elderly patients operated for hip fracture may be valuable in assessing and monitoring complications.
髋部骨折在老年人中是一种常见损伤，与功能障碍、并发症及死亡率的高发生率相关。
确定髋部骨折患者术后1个月内C反应蛋白（CRP）、纤维蛋白原和红细胞沉降率（ESR）的动态变化；研究这些参数与认知、手术类型、术后并发症、术后1个月功能水平及6个月死亡率之间的关系。
对32例接受髋部骨折手术的老年患者进行了为期6个月的前瞻性随访。记录骨折情况、手术类型及麻醉风险。采用简易精神状态检查表评估认知功能，采用Katz日常生活活动指数评估骨折前功能水平。随访内容包括并发症、死亡率及功能结局。分别在骨折后最初10小时、术后48 - 60小时、7天及30天评估CRP、纤维蛋白原和ESR。
仅发现有并发症患者与无并发症患者作为一个整体时CRP的动态变化存在差异（p = 0.006），且感染、谵妄和心血管并发症患者与无并发症患者之间也存在差异（分别为p = 0.06、0.03、0.02）。术后48 - 60小时，有并发症患者和无并发症患者的平均（±标准误）CRP分别为20.9 ± 2.1和13.1 ± 1.6mg/dl（p = 0.002）。术后48 - 60小时的平均CRP与曲线下面积高度相关，R = 0.88（p < 0.001）。计算得出术后48 - 60小时并发症患者CRP的临界值为15mg/dl（敏感性93%，特异性65%，p = 0.003）。CRP、纤维蛋白原和ESR与骨折类型、手术类型、认知、麻醉风险、术后1个月功能及6个月死亡率无关。
对接受髋部骨折手术的老年患者进行CRP检测可能对评估和监测并发症具有重要价值。
Zotero 插件