老年髋部骨折手术患者慢性肾脏病与术后心血管事件风险。

Chronic kidney disease and risk of postoperative cardiovascular events in elderly patients receiving hip fracture surgery.

机构信息

Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China, 100853; Medical School of Chinese PLA, Beijing, China, 100853.

National Clinical Research Centre for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China, 100853.

出版信息

Injury. 2022 Feb;53(2):596-602. doi: 10.1016/j.injury.2021.12.032. Epub 2021 Dec 23.

DOI:10.1016/j.injury.2021.12.032

PMID:34974909

Abstract

INTRODUCTION

The long-term risk of cardiovascular events caused by chronic kidney disease (CKD) is well described in the general population. Less is known concerning the risk of postoperative cardiovascular events in geriatric hip fracture patients with CKD.

METHODS

This study involved patients at least 65 years of age who received surgery for acute hip fracture between January 2000 and April 2016. We identified CKD patients with a baseline diagnosis of CKD or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m at admission. Each CKD patient was matched, for age, gender, fracture type, and year of admission, with 4 control non-CKD patients. The primary endpoint was a compositepostoperative cardiovascular events, including pulmonary embolism, angina pectoris, myocardial infarction, heart failure, arrhythmia, stroke, and death. Conditional logistic regression was used to evaluate the association between CKD and the outcome after adjusting for potential confounders including age, gender, fracture type, body mass index, preexisting comorbidities, history of cardiovascular events, and the Charlson Comorbidity Index (CCI).

RESULTS

Three hundred and seventy-five CKD patients were matched with 1,438 non-CKD patients. The mean age of the CKD patients was 81.9 ± 7.0 (mean ± SD), 69.9% were females, and 59.2% had an intertrochanteric fracture. Compared to non-CKD patients, CKD patients had a higher proportion of preexisting comorbidities, including hypertension, coronary heart disease, heart failure, and type 2 diabetes (all p < 0.05). The risk of postoperative cardiovascular events was 125.3 per 1000 persons (95%CI, 91.8-158.8) in CKD patients and 64.7 per 1000 persons (95%CI, 52.0-77.4) in non-CKD patients. A 1.96-fold risk of cardiovascular events after hip fracture surgery was found in CKD patients than those without CKD (adjusted OR, 1.96; 95%CI, 1.23-3.12).

CONCLUSION

Patients with CKD were more likely to have cardiovascular events after hip fracture surgery than those without CKD. Appropriate preoperative cardiovascular risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate such complications.

摘要

简介

慢性肾脏病（CKD）导致的心血管事件长期风险在普通人群中已有充分描述。对于 CKD 老年髋部骨折患者，术后发生心血管事件的风险知之甚少。

方法

本研究纳入了 2000 年 1 月至 2016 年 4 月期间因急性髋部骨折接受手术治疗的年龄至少 65 岁的患者。我们将入院时存在 CKD 诊断或估计肾小球滤过率（eGFR）<60mL/min/1.73m2的患者识别为 CKD 患者。每例 CKD 患者均与年龄、性别、骨折类型和入院年份相匹配的 4 例非 CKD 对照组患者进行匹配。主要终点是包括肺栓塞、心绞痛、心肌梗死、心力衰竭、心律失常、卒中和死亡在内的术后复合心血管事件。使用条件逻辑回归评估在调整了年龄、性别、骨折类型、体重指数、并存疾病、心血管事件史和 Charlson 合并症指数（CCI）等潜在混杂因素后，CKD 与结局之间的关联。

结果

375 例 CKD 患者与 1438 例非 CKD 患者相匹配。CKD 患者的平均年龄为 81.9±7.0（均值±标准差），69.9%为女性，59.2%为股骨转子间骨折。与非 CKD 患者相比，CKD 患者的并存疾病比例更高，包括高血压、冠心病、心力衰竭和 2 型糖尿病（均 P<0.05）。CKD 患者术后心血管事件的风险为 125.3/1000 人（95%CI，91.8-158.8），而非 CKD 患者为 64.7/1000 人（95%CI，52.0-77.4）。与非 CKD 患者相比，CKD 患者髋部骨折手术后发生心血管事件的风险增加 1.96 倍（校正 OR，1.96；95%CI，1.23-3.12）。