Department of Nutritional Sciences, and the Institute of Food, Nutrition & Health, Rutgers University, New Brunswick, NJ 08901, USA.
Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
J Clin Endocrinol Metab. 2023 Dec 21;109(1):e18-e24. doi: 10.1210/clinem/dgad502.
Hip fracture is a serious injury that can lead to increased morbidity and mortality. Vitamin D binding protein (DBP) is a potential prognostic indicator of outcomes since it is important for actin scavenging and inflammation after tissue injury.
To determine whether circulating DBP is associated with mobility or mortality after hip fracture and its association with acute tissue injury markers.
Post hoc analysis of a multisite North American prospective study of 260 patients with hip fracture; mobility assessed at 30 and 60 days and mortality at 60 days after repair surgery. Biochemical markers were measured before, and 2 to 4 days after surgery. Tissue injury markers were measured in 100 randomly selected patients and controls. The primary outcome was mobility and mortality by DBP tertiles. Secondary outcomes were assessment of pre- and postoperative biomarkers.
Among all patients (81 ± 9 years, BMI 25 ± 4 kg/m2; 72% female), the highest DBP tertile had greater mobility at 30 (OR: 2.66; 95% CI: 1.43, 4.92; P = .002) and 60 days (OR: 2.31; 95% CI: 1.17, 4.54; P = .014) and reduced mortality (OR: 0.18; 95% CI: 0.04, 0.86; P = .032) compared with the lowest DBP tertile (<28.0 mg/dL). Total 25-hydroxyvitamin-D did not differ between tertiles (22.0 ± 9.5 ng/mL). Circulating DBP and gelsolin were lower and interleukin-6, C-reactive protein, and F-actin were higher (P < .01) in patients vs controls, and worsened (P < .01) after surgery.
High circulating DBP concentrations are associated with better mobility and reduced mortality after hip fracture surgery. The role of DBP as an acute phase reactant to tissue injury and clinical outcomes should be addressed in future study.
髋部骨折是一种严重的损伤，可导致发病率和死亡率增加。维生素 D 结合蛋白（DBP）是一种潜在的预后指标，因为它对于组织损伤后的肌动蛋白清除和炎症很重要。
确定循环 DBP 是否与髋部骨折后的活动能力或死亡率相关，以及其与急性组织损伤标志物的关系。
对北美 260 例髋部骨折多中心前瞻性研究的事后分析；在修复手术后 30 天和 60 天评估活动能力，在 60 天评估死亡率。在手术前和手术后 2 至 4 天测量生化标志物。在 100 名随机选择的患者和对照组中测量组织损伤标志物。主要结局是根据 DBP 三分位值评估活动能力和死亡率。次要结局是评估术前和术后的生物标志物。
在所有患者中（81±9 岁，BMI 25±4kg/m2；72%为女性），最高 DBP 三分位组在 30 天（OR：2.66；95%CI：1.43，4.92；P=0.002）和 60 天（OR：2.31；95%CI：1.17，4.54；P=0.014）时活动能力更高，死亡率更低（OR：0.18；95%CI：0.04，0.86；P=0.032），与最低 DBP 三分位组（<28.0mg/dL）相比。三分位组之间的总 25-羟维生素 D 无差异（22.0±9.5ng/mL）。与对照组相比，患者的循环 DBP 和凝胶蛋白较低，白细胞介素-6、C 反应蛋白和 F-肌动蛋白较高（P<0.01），手术后进一步恶化（P<0.01）。
循环 DBP 浓度较高与髋部骨折手术后活动能力更好和死亡率降低相关。DBP 作为组织损伤和临床结局的急性期反应物的作用应在未来的研究中进一步探讨。
