Kovar Florian M, Endler Georg, Wagner Oswald F, Wippel Andreas, Jaindl Manuela
Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Austria.
Institute of Central Laboratory, General Hospital Vienna, Medical University Vienna, Austria; Labors.at, Vienna, Austria.
Injury. 2016 Mar;47(3):728-32. doi: 10.1016/j.injury.2015.11.033. Epub 2015 Dec 17.
Fractures of the proximal femur are a significant cause of mortality and morbidity in the elderly population. Yet predictive marker of unfavourable prognosis are still lacking. Calcium phosphate product is a marker of osteo-renal dysregulation. This study investigated the role of serum calcium phosphate product (SCPP) levels as a prognostic parameter for outcome in those patients.
A total of 3577 consecutive patients with diagnosed fractures of the proximal femur were included in our study (72.5% females). SCPP was divided into tertiles: <1.92mmol(2)/l(2), 1.93-2.38mmol(2)/l(2) and >2.39mmol(2)/l(2). Data collection was performed prospectively and statistical evaluation was performed retrospectively.
Mean follow up in our study group was 11.0±0.3 months. The mean age of our study group was 79.0 years (SEM ±14 years). To facilitate analysis, patients were divided in two groups: ≤84 years (64.4%) and ≥85 years (35.6%), and mortality <12 months was 12.4% (n=445). In our study population higher SCPP levels ad admission were associated with a markedly elevated mortality. In a multivariate logistic regression model adjusted for age and sex, plasma creatinine and haemoglobin at admission caused a 1.3 (CI: 1.01-1.6) for SCPP 1.93-2.38mmol(2)/l(2), and a 1.6 (CI: 1.2-2.0) for SPP >2.39mmol(2)/l(2) fold increase in overall mortality compared to patients with baseline SCPP levels (<1.92mmol(2)/l(2)) as reference category.
Those findings in our study population with 3577 patients over a period of 20 years proved to be, that serum Ca levels may be a good predictor for mortality in patients with fracture of the proximal femur. Further studies are required to evaluate whether these high risk patients might benefit from specific therapeutic measurements. This prognostic factor may help to increase the outcome of elderly patients with a fracture of the proximal femur.
股骨近端骨折是老年人群死亡和发病的重要原因。然而，目前仍缺乏不良预后的预测指标。磷酸钙产物是骨-肾调节异常的一个指标。本研究调查了血清磷酸钙产物（SCPP）水平作为这些患者预后参数的作用。
本研究共纳入3577例连续诊断为股骨近端骨折的患者（72.5%为女性）。SCPP分为三个三分位数：<1.92mmol(2)/l(2)、1.93 - 2.38mmol(2)/l(2)和>2.39mmol(2)/l(2)。数据收集是前瞻性进行的，统计评估是回顾性进行的。
我们研究组的平均随访时间为11.0±0.3个月。研究组的平均年龄为79.0岁（标准误±14岁）。为便于分析，患者分为两组：≤84岁（64.4%）和≥85岁（35.6%），12个月内的死亡率为12.4%（n = 445）。在我们的研究人群中，入院时较高的SCPP水平与显著升高的死亡率相关。在调整了年龄、性别、入院时血浆肌酐和血红蛋白的多因素逻辑回归模型中，与基线SCPP水平（<1.92mmol(2)/l(2)）作为参考类别相比，SCPP为1.93 - 2.38mmol(2)/l(2)时总体死亡率增加1.3倍（置信区间：1.01 - 1.6），SCPP>2.39mmol(2)/l(2)时总体死亡率增加1.6倍（置信区间：1.2 - 2.0）。
在20年期间对3577例患者的研究人群中的这些发现表明，血清钙水平可能是股骨近端骨折患者死亡率的良好预测指标。需要进一步研究以评估这些高危患者是否可能从特定治疗措施中获益。这一预后因素可能有助于提高老年股骨近端骨折患者的治疗效果。
