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Wei Z, Gao X, Wang J, Wang Y, Tang H, Ma Z, Wang J, Chen X. Triglyceride glucose index is associated with vertebral fracture in older adults: a longitudinal study. Endocrine 2025; 87:1022-1030. [PMID: 39699802 DOI: 10.1007/s12020-024-04136-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 12/10/2024] [Indexed: 12/20/2024]
Abstract
PURPOSE Diabetes is a risk factor for bone fractures. However, the association between insulin resistance and the risk of fracture has not been well studied. In the present study, we explored the association of the triglyceride glucose index as a measure of insulin resistance with the risk of vertebral fracture in older adults. METHODS A total of 1995 subjects aged 50 years or older who underwent computed tomography (CT) for lung cancer screening from 2016-2021 were included in this study. They were followed until July 2023. Demographic information and laboratory test data were collected from the electronic medical system. Vertebral fractures were evaluated on the basis of sagittal CT images of the spine. The triglyceride glucose (TYG) index was calculated via the following equation: Ln [fasting glucose (mg/dl)×fasting triglyceride (mg/dl)/2]. The association between the TYG index and vertebral fracture incidence was evaluated via a multivariable Cox proportional hazards model. RESULTS Ninety-five cases of fracture were observed during the 60 months of follow-up. The incidence of fracture was lower for the fourth TYG index than for the first TYG index (3.26% vs. 6.00%, P = 0.04). The risk of vertebral fracture decreased with increasing TYG index (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.35-0.90). Fracture risk was significantly lower in subjects with the highest TYG (the fourth quartile) than in those with the first quartile (aHR: 0.46, 95% CI: 0.22-0.96) according to the fully adjusted model. A similar association was observed in subjects without diabetes (aHR = 0.44, 95% CI: 0.21-0.95). Restricted cubic splines further revealed that the risk of vertebral fracture decreased with increasing TYG index. CONCLUSION A greater TYG index was associated with a lower risk of vertebral fracture, independent of body mass index and bone mass.
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Affiliation(s)
- Zicheng Wei
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xifa Gao
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiangchuan Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongye Tang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhenyuan Ma
- Department of Orthopaetics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Ren Y, Wen Z, Zhou S, Lu L, Hua Z, Sun Y. Association of preoperative blood biomarkers with postoperative major adverse cardiac events and mortality in major orthopaedic surgery: a systematic review and meta-analysis. BMJ Open 2025; 15:e086263. [PMID: 39819956 PMCID: PMC11752069 DOI: 10.1136/bmjopen-2024-086263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 12/13/2024] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVE The association between preoperative blood biomarkers and major adverse cardiac events (MACEs) as well as mortality after major orthopaedic surgery remains unclear. This study aimed to assess the association between preoperative blood biomarkers and postoperative MACEs as well as all-cause mortality in patients undergoing major orthopaedic surgery. DESIGN A systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, the Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews from inception to 20 October 2024 were searched. ELIGIBILITY CRITERIA Observational or experimental studies reporting the correlation between preoperative blood biomarkers and postoperative MACEs-categorised as short-term (within 3 months) or long-term (beyond 3 months)-and all-cause mortality in patients undergoing major orthopaedic surgery. DATA EXTRACTION AND SYNTHESIS Data from studies reporting OR or HR and its 95% CI were pooled for analysis using random-effects model. RESULTS 21 preoperative blood-based biomarkers from 80 studies with 226 468 patients were analysed. Elevated preoperative cardiac biomarkers were correlated with a heightened risk of MACEs within 3 months (natriuretic peptide: OR 3.37, 95% CI 2.07 to 5.47, I2=87.9%; cardiac troponin: OR 4.89, 95% CI 1.52 to 15.75, I2=69.5%) with significant heterogeneity. Only natriuretic peptide was associated with a high-risk long-term MACEs (>3 months) (OR 3.52, 95% CI 1.73 to 7.17, I2=86.2%). In contrast, cardiac biomarkers were not identified as having prognostic value for all-cause mortality in this patient cohort. Additionally, an increased risk of all-cause mortality was associated with preoperative abnormal levels of albumin (OR 1.15, 95% CI 1.06 to 1.24, I2=84.8%), creatinine (OR 1.54, 95% CI 1.12 to 1.95, I2=0), 25(OH)D (OR 1.58, 95% CI 1.01 to 2.14, I2=0) and glomerular filtration rate (GFR) (OR 1.12, 95% CI 1.06 to 1.17, I2=0), rather than cardiac biomarkers. CONCLUSIONS The study proposed that cardiac biomarkers assessed before surgery could offer prognostic insight into short-term MACEs, while preoperative abnormal levels of albumin, creatinine, 25 (OH)D and GFR might be prognostic valuable for all-cause mortality following major orthopaedic surgery. PROSPERO REGISTRATION NUMBER CRD42022352091.
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Affiliation(s)
- Yi Ren
- Department of Anesthesiology, Beijing Hospital, National Center of Geronotology, Insititute of Geriatric Medicine, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhenghao Wen
- Jiamusi University, Jiamusi, Heilongjiang, China
| | - Suzhen Zhou
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Lu
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Hua
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanxia Sun
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Ding K, Shang Z, Sun D, Yang W, Zhang Y, Wang L, Zhang T, Du X, Dai Y, Zhu Y, Chen W. The admission inflammatory biomarkers profile of elderly hip fractures and its association with one-year walking independence and mortality: a prospective study. INTERNATIONAL ORTHOPAEDICS 2025; 49:19-28. [PMID: 39466411 DOI: 10.1007/s00264-024-06353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 10/11/2024] [Indexed: 10/30/2024]
Abstract
PURPOSE Immune response plays an important role in the regulation of elderly hip fracture. This study aims to analyze the relationship between systemic inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) and mortality and walking independence, providing valuable references for the postoperative management of geriatric hip fracture. METHODS A retrospective analysis of prospective data on elderly patients who have undergone hip surgery and have been followed for at least one year. The receiver operating characteristic (ROC) curves and the optimum cutoff value were calculated. Univariate analysis and multivariate logistic regression analysis were used to identify the associations between admission four systemic inflammatory markers and one-year mortality and locomotion recovery. RESULTS During the study period, respiratory disease was the most common cause of death, followed by cardiovascular disease. Multivariate analysis identified NLR (OR, 1.13; 95%CI: 1.09-1.17), SIRI(OR, 1.18; 95%CI: 1.08-1.28) and advanced age (OR, 1.06; 95%CI: 1.01-1.11) as independent risk factors for one-year mortality. In addition, 89 (rate, 31.8%) survivors had poor walking independence within one year. NLR (OR, 1.37; 95%CI: 1.26-1.50), SII(OR, 1.00; 95%CI: 1.001-1.003), SIRI(OR, 1.36; 95%CI: 1.18-1.57) and advanced age (OR, 1.08; 95%CI: 1.02-1.13) were associated with postoperative locomotion recovery. CONCLUSIONS In summary, admission NLR and SIRI are correlated with a high risk of one-year walking independence and mortality, providing a basis for the clinical management of geriatric hip fractures.
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Affiliation(s)
- Kai Ding
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Zeyu Shang
- Advanced Biomedical Imaging, University College London, London, United Kingdom
| | - Dacheng Sun
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Weijie Yang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Yifan Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Ling Wang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Tao Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Xiaofeng Du
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China
| | - Yajiang Dai
- Grade 2023 Basic Medical Class, School of Basic Medicine, Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China.
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China.
| | - Wei Chen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Hebei, People's Republic of China.
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Beijing, People's Republic of China.
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Fisher A, Wang JWD, Smith PN. Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes. Int J Clin Pract 2024; 2024:1-26. [DOI: 10.1155/2024/4456803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2025] Open
Abstract
Objective. Although the association between chronic kidney disease (CKD) and osteoporotic fractures is well established, data on CKD combined with hip fracture (HF) are scarce and controversial. We aimed to assess in patients with HF the prevalence of CKD, its impact on hospital mortality and length of stay (LOS) and to determine the prognostic value of CKD to predict hospital outcomes. Methods. Prospectively collected clinical data were analysed in 3623 consecutive HF patients aged ≥65 years (mean age 83.4 ± 7.50 [standard deviation] years; 74.4% females). Results. CKD among older patients with HF is highly prevalent (39.9%), has different clinical characteristics, a 2.5-fold higher mortality rate, and 40% greater risk of prolonged LOS. The strongest risk for a poor outcome was advanced age (>80 years). The risk of death substantially increases in combination with chronic disorders, especially coronary artery disease, anaemia, hyperparathyroidism, and atrial fibrillation; models based only on three variables—CKD stage, age >80, and presence of a specific chronic condition—predicted in-hospital death with good discrimination capability (AUC ≥ 0.700) and reasonable accuracy, the number needed to predict ranged between 5.7 and 14.5. Only 12% of HF patients received osteoporotic drugs prefracture. Conclusion. In HF patients with CKD, the risk of adverse outcomes largely increases in parallel with worsening kidney function and, especially, in combination with comorbidities; models based on three admission variables predict a fatal outcome. Assessment of renal function is essential to preventing osteoporotic fractures.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra 2614, Australia
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra 2614, Australia
- Australian National University Medical School, Canberra 2614, Australia
| | - Jo-Wai Douglas Wang
- Department of Geriatric Medicine, The Canberra Hospital, Canberra 2614, Australia
- Australian National University Medical School, Canberra 2614, Australia
| | - Paul N. Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra 2614, Australia
- Australian National University Medical School, Canberra 2614, Australia
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Zhang BF, Liu L, Xu K, Xu P. Serum cystatin C as a biomarker to predict all-cause mortality in geriatrics hip fracture. Heliyon 2024; 10:e24037. [PMID: 38283240 PMCID: PMC10818208 DOI: 10.1016/j.heliyon.2024.e24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Background Cystatin C, a low-molecular-weight protein, belongs to cysteine protease inhibitors produced primarily by nucleated cells. Its serum concentration, independent of sex, age, or muscle mass, is a good predictor of renal dysfunction in older adults. This study evaluated the association between all-cause mortality and preoperative cystatin C levels in hip fractures. Materials and methods Data describing the demographic and clinical characteristics of the patients were gathered specifically from older individuals who had suffered hip fractures. The study used linear and non-linear multivariate Cox regression models to investigate the association between preoperative cystatin C levels and mortality. The analyses were conducted using the R and EmpowerStats software. Results In total, two thousand three hundred and ninety-four patients were included in this study. A total of 790 patients (33 %) died of all causes. The mean follow-up was 37.62 months. The preoperative cystatin C was 0.91 ± 0.41 mg/L. Linear multivariate Cox regression analysis revealed a significant association between preoperative cystatin C level and death, with a hazard ratio (HR) of 2.19 (95 % confidence interval [CI]: 1.72-2.79, P < 0.0001). Nevertheless, the correlation between the variables was inconsistent. A cystatin C concentration of 1.62 mg/L marked a significant change in the non-linear relationship. A preoperative cystatin C level below 1.62 mg/L was found to be significantly linked with an increased risk of mortality (HR = 2.60, 95 % CI: 1.92-3.52, P < 0.0001). The mortality reached its highest point when the preoperative cystatin C level was greater than 1.62 mg/L. After that, the mortality risk did not increase further (HR = 1.54, 95 % CI: 0.98-2.42, P = 0.0588). The non-linear relationship remained consistent in the propensity score-matching sensitive analysis. Conclusions The study found a non-linear relationship between preoperative cystatin C levels and mortality in geriatric hip fractures. This suggests that preoperative cystatin C can be used as a predictor of the risk of death. The registration number is ChiCTR2200057323.
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Affiliation(s)
- Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Lin Liu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Ke Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Peng Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Wu R, Ma Y, Chen D, Li M, Li Z, Deng Z, Zheng Q, Fu G. Bone turnover biomarkers predict one-year all-cause mortality and walking ability in geriatric hip fracture patients. Bone 2023; 177:116922. [PMID: 37775069 DOI: 10.1016/j.bone.2023.116922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To investigate the utility of serum C-terminal cross-linking telopeptides (β-CTX) and procollagen type I N propeptide (PINP) for predicting one-year mortality and walking ability in Chinese geriatric hip fracture patients who underwent surgical interventions. METHOD Elderly patients (≥ 60 years) who underwent surgical interventions for unilateral low-energy hip fracture from 2015 to 2020 in our center were included. Demographic data was retrospectively retrieved from the electronic medical database. The PINP and β-CTX concentrations were measured before the surgery. The patients were divided into two groups according to the outcome of mortality and walking ability after hip surgery, respectively. β-CTX and PINP were divided into four grades based on quartiles [Quartile(Q)1-4] for further analysis. All the variables with p < 0.1 in univariable analysis were included in a multivariable model. RESULTS In univariable analysis, the levels of serum β-CTX (p = 0.007) and PINP (p = 0.025) was associated with one-year mortality, while the association between levels of serum β-CTX (p = 0.072) or PINP (p = 0.055) with one-year disability was marginally significant. After adjustment for confounders, the relative risk [OR (95 % CI), Q4 v sQ1, p-value] of one-year mortality and one-year disability were 7.28 (2.08-29.78, p = 0.003) and 3.97 (1.44-11.69, p = 0.009) for β-CTX and 5.87 (1.70-23.80, p = 0.008) and 3.48 (1.30-9.93, p = 0.016) for PINP, respectively. The coefficient of determination, AUC and bias-corrected C-index of predictive models based on previously reported predictors were significantly improved after integrating β-CTX or PINP. CONCLUSION Higher serum β-CTX and PINP are independently associated with an increased risk of one-year mortality and disability in patients with hip fractures. The application of BTMs improves the performance of currently available predictive models.
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Affiliation(s)
- Rongjie Wu
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China; Shantou University Medical College, Shantou, Guangdong Province, PR China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China
| | - Duanyong Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, PR China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China
| | - Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China
| | - Zhantao Deng
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China.
| | - Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, PR China.
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Yeung WCG, Palmer SC, Strippoli GFM, Talbot B, Shah N, Hawley CM, Toussaint ND, Badve SV. Vitamin D Therapy in Adults With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2023; 82:543-558. [PMID: 37356648 DOI: 10.1053/j.ajkd.2023.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/24/2023] [Indexed: 06/27/2023]
Abstract
RATIONALE & OBJECTIVE Vitamin D is widely used to manage chronic kidney disease-mineral and bone disorder (CKD-MBD). We evaluated the effects of vitamin D therapy on mortality, cardiovascular, bone, and kidney outcomes in adults with CKD. STUDY DESIGN Systematic review of randomized controlled trials (RCT) with highly sensitive searching of MEDLINE, Embase, and CENTRAL, through February 25, 2023. SETTING & STUDY POPULATIONS Adults with stage 3, 4, or 5 CKD, including kidney failure treated with dialysis. Recipients of a kidney transplant were excluded. SELECTION CRITERIA FOR STUDIES RCTs with≥3 months of follow-up evaluating a vitamin D compound. DATA EXTRACTION Data were extracted independently by three investigators. ANALYTICAL APPROACH Treatment estimates were summarized using random effects meta-analysis. Primary review endpoints were all-cause death, cardiovascular death, and fracture. Secondary outcomes were major adverse cardiovascular events, hospitalization, bone mineral density, parathyroidectomy, progression to kidney failure, proteinuria, estimated glomerular filtration rate, hypercalcemia, hyperphosphatemia, biochemical markers of CKD-MBD, and various intermediate outcome measures of cardiovascular disease. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2 tool. Evidence certainty was adjudicated using GRADE. RESULTS Overall, 128 studies involving 11,270 participants were included. Compared with placebo, vitamin D therapy probably had no effect on all-cause death (relative risk [RR], 1.04; 95% CI, 0.84-1.24); and uncertain effects on fracture (RR, 0.68; 95% CI, 0.37-1.23) and cardiovascular death (RR, 0.73; 95% CI, 0.31-1.71). Compared with placebo, vitamin D therapy lowered serum parathyroid hormone and alkaline phosphatase, but increased serum calcium. LIMITATIONS Data were limited by trials with short-term follow-up periods, small sample size, and the suboptimal quality. CONCLUSIONS Vitamin D therapy did not reduce the risk of all-cause death in people with CKD. Effects on fracture and cardiovascular and kidney outcomes were uncertain. TRIAL REGISTRATION Registered at PROSPERO with study number CRD42017057691. PLAIN-LANGUAGE SUMMARY Chronic kidney disease (CKD) is associated with increased risk of death, cardiovascular disease, and fractures. This excess risk is thought to be related to changes in bone and mineral metabolism, leading to the development of CKD-mineral and bone disorder (CKD-MBD) which is characterized by vascular calcification and reduced bone quality. Vitamin D is commonly used in the treatment of this condition. We reviewed randomized controlled trials examining the effect of vitamin D therapy in CKD. We found that vitamin D therapy affects serum biomarkers, including an increase in serum calcium. However, it probably has no effect on risk of all-cause death in CKD, and the effects on other clinical bone, cardiovascular, and kidney outcomes are uncertain.
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Affiliation(s)
- Wing-Chi G Yeung
- Department of Nephrology, Wollongong Hospital, Sydney, Australia; George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Benjamin Talbot
- George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nasir Shah
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carmel M Hawley
- Translational Research Institute, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Nigel D Toussaint
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, University of Melbourne, Parkville, Australia
| | - Sunil V Badve
- Department of Nephrology, St George Hospital, Sydney, Australia; George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
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Wu CY, Tsai CF, Yang HY. Utilizing a nomogram to predict the one-year postoperative mortality risk for geriatric patients with a hip fracture. Sci Rep 2023; 13:11091. [PMID: 37422577 PMCID: PMC10329653 DOI: 10.1038/s41598-023-38297-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
Despite the abundance of research on the risk factors for mortality following hip fracture surgery, there has been a dearth of studies on prediction models in this population. The objective of this research was to explore the influencing factors and construct a clinical nomogram to predict one-year postoperative mortality in patients with hip fracture surgeries. Using the Ditmanson Research Database (DRD), we included 2333 subjects, aged ≥ 50 years who underwent hip fracture surgery between October, 2008 and August, 2021. The endpoint was all-cause mortality. A least absolute shrinkage and selection operator (LASSO) derived Cox regression was performed to select the independent predictors of one-year postoperative mortality. A nomogram was built for predicting one-year postoperative mortality. The prognostic performance of nomogram was evaluated. On the basis of tertiary points in a nomogram, the patients were divided into low, middle and high risk groups, and compared by the Kaplan-Meier analysis. Within 1 year after hip fracture surgery, 274 patients (11.74%) died. Variables retained in the final model comprised age, sex, length of stay, RBC transfusions, hemoglobin, platelet, and eGFR. The AUC for one-year mortality predictions were 0.717 (95% CI = 0.685-0.749). The Kaplan-Meier curves were significantly different among the three risk groups (p < 0.001). The nomogram showed good calibration. In summary, we explored the one-year postoperative mortality risk in geriatric patients with a hip fracture and developed a prediction model that could help clinicians identify patients at high risk of postoperative mortality.
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Affiliation(s)
- Cheng-Yi Wu
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Osteoporosis Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chiayi City, 60002, Taiwan
| | - Hsin-Yi Yang
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chiayi City, 60002, Taiwan.
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9
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Agogo GO, Muchene L, Orindi B, Murphy TE, Mwambi H, Allore HG. A multivariate joint model to adjust for random measurement error while handling skewness and correlation in dietary data in an epidemiologic study of mortality. Ann Epidemiol 2023; 82:8-15. [PMID: 36972757 PMCID: PMC10239394 DOI: 10.1016/j.annepidem.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE A substantial proportion of global deaths is attributed to unhealthy diets, which can be assessed at baseline or longitudinally. We demonstrated how to simultaneously correct for random measurement error, correlations, and skewness in the estimation of associations between dietary intake and all-cause mortality. METHODS We applied a multivariate joint model (MJM) that simultaneously corrected for random measurement error, skewness, and correlation among longitudinally measured intake levels of cholesterol, total fat, dietary fiber, and energy with all-cause mortality using US National Health and Nutrition Examination Survey linked to the National Death Index mortality data. We compared MJM with the mean method that assessed intake levels as the mean of a person's intake. RESULTS The estimates from MJM were larger than those from the mean method. For instance, the logarithm of hazard ratio for dietary fiber intake increased by 14 times (from -0.04 to -0.60) with the MJM method. This translated into a relative hazard of death of 0.55 (95% credible interval: 0.45, 0.65) with the MJM and 0.96 (95% credible interval: 0.95, 0.97) with the mean method. CONCLUSIONS MJM adjusts for random measurement error and flexibly addresses correlations and skewness among longitudinal measures of dietary intake when estimating their associations with death.
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Affiliation(s)
- George O Agogo
- StatsDecide Analytics and Consulting Ltd, Nakuru, Kenya.
| | | | - Benedict Orindi
- Department of Statistics, Center for Geographic Medicine Research, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Terrence E Murphy
- Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg Campus, Pietermaritzburg, South Africa
| | - Heather G Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT
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10
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Chen BK, Liu YC, Chen CC, Chen YP, Kuo YJ, Huang SW. Correlation between C-reactive protein and postoperative mortality in patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res 2023; 18:182. [PMID: 36894998 PMCID: PMC9996565 DOI: 10.1186/s13018-023-03516-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/08/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Hip fracture is a common but devastating disease with a high mortality rate in the older adult population. C-reactive protein (CRP) is a predictor of the prognosis in many diseases, but its correlations with patient outcomes following hip fracture surgery remain unclear. In this meta-analysis, we investigated the correlation between perioperative CRP level and postoperative mortality in patients undergoing hip fracture surgery. METHODS PubMed, Embase, and Scopus were searched for relevant studies published before September 2022. Observational studies investigating the correlation between perioperative CRP level and postoperative mortality in patients with hip fracture were included. The differences in CRP levels between the survivors and nonsurvivors following hip fracture surgery were measured with mean differences (MDs) and 95% confidence intervals (CIs). RESULTS Fourteen prospective and retrospective cohort studies comprising 3986 patients with hip fracture were included in the meta-analysis. Both the preoperative and postoperative CRP levels were significantly higher in the death group than in the survival group when the follow-up duration was ≥ 6 months (MD: 0.67, 95% CI: 0.37-0.98, P < 0.0001; MD: 1.26, 95% CI: 0.87-1.65, P < 0.00001, respectively). Preoperative CRP levels were significantly higher in the death group than in the survival group when the follow-up duration was ≤ 30 days (MD: 1.49, 95% CI: 0.29-2.68; P = 0.01). CONCLUSIONS Both higher preoperative and postoperative CRP levels were correlated with higher risk of mortality following hip fracture surgery, suggesting the prognostic role of CRP. Further studies are warranted to confirm the ability of CRP to predict postoperative mortality in patients with hip fracture.
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Affiliation(s)
- Bing-Kuan Chen
- Department of General Medicine, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Yu-Cheng Liu
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Ching Chen
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.
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11
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Huo Z, Liu X, Wu Y, Liang Y, Xu R, Ma Y, Song L, Shen J, Tang X. Development of chemiluminescence method based on serum type I collagen hydroxyl terminal peptide β special sequence (β-CTX). Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:494-501. [PMID: 34325600 DOI: 10.1080/00365513.2021.1952484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this work is to develop and verify the analytical performance of a chemiluminescence immunoassay for the specific sequence β-carboxy-terminal cross-linking telopeptide of type I collagen (β-CTX) in human serum. Two specific monoclonal antibodies (mAb-8A03 and mAb-3D12) with high affinity for β-CTX were selected, and, under optimized conditions, a chemiluminescence immunoassay method (CLIA) for β-CTX was established. The CLIA of β-CTX detected β-CTX in a wide range of 2.0-6000 ng/L. The recovery rate in serum is 95-105%, the specificity is high, and the cross-reaction rate with common easily interfering substances is low (not more than 0.01%). The CLIA correlates well with Roche electrochemiluminescence immunoassay (ECLIA), with a correlation coefficient of 0.9551, which fully meets the requirements of clinical analysis. The developed β-CTX CLIA kit has high sensitivity and good stability. It has the same performance as the commercial Roche ECLIA kit and can be applied clinically.
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Affiliation(s)
- Zhen Huo
- Medcial School, Anhui University of Science & Technology, Huainan, China.,Institute of Environment-Friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Xueke Liu
- Department of Clinical Laboratory Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yongfeng Wu
- Department of Clinical Laboratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Yong Liang
- Huai'an Hospital, Xuzhou Medical College and Huai'an Second Hospital, Huai'an, China
| | - Ruyue Xu
- Medcial School, Anhui University of Science & Technology, Huainan, China.,Institute of Environment-Friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Yongfang Ma
- Medcial School, Anhui University of Science & Technology, Huainan, China.,Institute of Environment-Friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Li Song
- Medcial School, Anhui University of Science & Technology, Huainan, China.,Institute of Environment-Friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Jing Shen
- Medcial School, Anhui University of Science & Technology, Huainan, China.,Institute of Environment-Friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Xiaolong Tang
- Medcial School, Anhui University of Science & Technology, Huainan, China.,Institute of Environment-Friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
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12
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Fukuda T, Imai S, Simoda S, Nakdera M, Horiguchi H. Comparison of peripheral nerve block with local infiltration analgesia regarding walking ability after total knee replacement: A retrospective, propensity-score matched-pair cohort study. J Orthop Surg (Hong Kong) 2021; 28:2309499020931656. [PMID: 32564654 DOI: 10.1177/2309499020931656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE It is unclear whether perioperative analgesic techniques affect the functional outcome of total knee replacement (TKR). We investigated the effects of peripheral nerve block (PNB) and local infiltration (LI) on walking ability after TKR. METHODS The medical records of 7143 patients who underwent TKR using general anesthesia with PNB or LI techniques were reviewed. Factors affecting independence and/or improvement of walking after surgery were investigated using multivariate regression analysis. To adjust for baseline differences and minimize selection bias for the chosen analgesic technique, patients were matched by propensity scores. RESULTS The multivariate regression analysis showed that PNB was associated with independence and/or improvement of walking. Of the 7143 patients, 2755 (39%) received PNB analgesia and 4388 (61%) LI analgesia. After the propensity score matching, the analgesic types were not associated with walking ability. Independence reflected by the total score of daily living activities was higher in the PNB group than in the LI group. The PNB group started rehabilitation later but performed rehabilitation for longer in the initial period than the LI group. Consumption levels of fentanyl, pentazocine, and antiemetics were lower in the PNB group than in the LI group. The PNB group had fewer hypertensive episodes during surgery than the LI group. There was no significant difference in total hospitalization costs between the two groups. CONCLUSIONS No significant difference in postoperative walking ability was found between PNB and LI groups. However, PNB offered some advantages over LI. Future detailed investigations to improve TKR surgery are needed.
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Affiliation(s)
- Taeko Fukuda
- Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Kasumigaura Medical Center Hospital (Tsuchiura Center for Medical Education and Training), National Hospital Organization, Tsuchiura, Japan
| | - Shinobu Imai
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan.,Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Shunji Simoda
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan
| | - Masaya Nakdera
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research, National Hospital Organization Headquarters, Tokyo, Japan
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13
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Levi Y, Punchik B, Zikrin E, Shacham D, Katz D, Makulin E, Freud T, Press Y. Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population. Front Med (Lausanne) 2020; 7:592693. [PMID: 33163503 PMCID: PMC7581791 DOI: 10.3389/fmed.2020.592693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/10/2020] [Indexed: 01/30/2023] Open
Abstract
Background: As the population ages, the rate of hip fractures and the need for rehabilitation increases. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks. Methods: A retrospective study of patients 65 years and above following surgery to repair a hip fracture who underwent HBR or IR between 2016 and 2019. The two rehabilitation frameworks were compared for rehabilitation outcome and factors predicting successful rehabilitation. The outcome was determined with the Montebello Rehabilitation Factor Score-Revised (MRFS-R). Results: Data were collected for 235 patients over 3 years. The mean age was 81.3 ± 8.0 and 172 (73.3%) were women. Of these, 138 underwent IR and 97 HBR. The HBR group had better family support and fewer lived alone. There were also differences in the type of fracture and surgery. The medical condition of the IR group was more complex, as reflected in a higher Charlson's comorbidity scores, higher rates for delirium and more infectious complications, a lower Norton score, lower serum hemoglobin, and albumin levels, and higher serum creatinine and urea levels. It also had a more significant functional decline after surgery and required a longer rehabilitation period. However, no difference was found in the rehabilitation outcomes between the two groups (MRFS-R ≥ 50). The independent predictors for rehabilitation in the IR group were serum albumin level, comorbidity, and cognitive state. There were no independent predictors in the HBR group. Conclusions: In this retrospective study, there was no significant difference in short-term rehabilitation outcomes between the HBR and IR groups event though the patients in the IR group were medically more complex. This result should be taken into account when planning rehabilitation services after hip fracture and tailoring rehabilitation frameworks to patients.
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Affiliation(s)
- Yael Levi
- Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Home Care Unit, Clalit Health Services, Beer-Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeniya Zikrin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - David Shacham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Dori Katz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Evgeni Makulin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel.,Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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14
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Lin JC, Liu ZG, Liu RR, Xie LW, Xie HL, Cai HG. The increase of osteopontin and β-carboxy-terminal cross-linking telopeptide of type I collagen enhances the risk of hip fracture in the elderly. J Clin Lab Anal 2020; 34:e23204. [PMID: 32406547 PMCID: PMC7246377 DOI: 10.1002/jcla.23204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/17/2019] [Accepted: 12/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hip fracture in the elderly is a health burden worldwide due to its high mortality rate. This study was conducted to determine the possible mechanisms of osteopontin (OPN) and β-carboxy-terminal cross-linking telopeptide of type I collagen (β-CTX) in hip fracture in the elderly. MATERIALS AND METHODS In the study, we recruited 108 elderly patients with hip fracture diagnosed from May 2012 to May 2015 at the Third Hospital of Xiamen and 86 healthy individuals without a history of hip fracture were taken as controls. Serum levels of OPN and β-CTX were then determined. The T and Z values for bone mineral density (BMD) were also measured. Moreover, logistic regression analysis was performed to assess the risk and protective factors for hip fracture in the elderly. RESULTS Serum levels of both OPN and β-CTX were increased in elderly patients with hip fracture. OPN was positively correlated with β-CTX. In addition, the levels of OPN and β-CTX shared a positive association with the age, and a negative association with the BMD, in terms of T and Z values of the hip. In addition, increased BMD and outdoor sports might be protective factors for hip fracture, and an increase in levels of OPN and β-CTX might be associated with a higher risk of hip fracture in the elderly population. DISCUSSION Collectively, increased serum levels of OPN and β-CTX might be correlated with a higher risk of a hip fracture and have predictive values in the occurrence of hip fracture in the elderly.
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Affiliation(s)
- Jian-Chun Lin
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, China
| | - Zhong-Guo Liu
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, China
| | - Rui-Ren Liu
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, China
| | - Liang-Wen Xie
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, China
| | - Huang-Lin Xie
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, China
| | - He-Guo Cai
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, China
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15
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Fukuda T, Imai S, Nakadera M, Wagatsuma Y, Horiguchi H. Postoperative daily living activities of geriatric patients administered general or spinal anesthesia for hip fracture surgery: A retrospective cohort study. J Orthop Surg (Hong Kong) 2019; 26:2309499017754106. [PMID: 29366390 DOI: 10.1177/2309499017754106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Maintaining independence after hip fracture repair is important for geriatric patients and general welfare. We investigated the effects of anesthetic methods on postoperative activities of daily living (ADLs) following hip fracture surgery in elderly patients. METHODS The medical records of 12,342 patients aged ≥65 years who underwent typical surgeries for hip fracture using either general anesthesia or spinal anesthesia were reviewed. To adjust for baseline differences and minimize selection bias for the chosen method of anesthesia, patients were matched by propensity scores. Factors affecting the deterioration in ADLs during hospital stay were also investigated in all subjects using a multivariate logistic regression analysis. Eating, grooming, toileting, bathing, and walking were selected as the ADL parameters, as they are considered important for an independent life. RESULTS Of the 12,342 patients, 6918 (56.1%) received general anesthesia and 5424 (43.9%) received spinal anesthesia. After the propensity score matching, the anesthesia types were not associated with ADL scores except toileting at discharge. Results from the multivariate logistic regression analysis showed that the types of anesthesia were not associated with deterioration in ADL scores. Advanced age, male sex, high Charlson Comorbidity Index scores, psychiatric disease, no administration of nonsteroidal anti-inflammatory drugs, and short length of hospital stay were associated with deterioration in ADL scores. CONCLUSION The anesthesia types were not associated with ADL dependency except toileting at discharge. Spinal anesthesia adversely affected toilet use at hospital discharge. However, anesthesia types were not factors that affected deterioration in ADL during hospital stay in elderly patients who underwent hip fracture surgery.
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Affiliation(s)
- Taeko Fukuda
- 1 University of Tsukuba, Tsukuba, Ibaraki, Japan.,2 Faculty of Medicine, Department of Anesthesiology, Tsuchiura Center for Medical Education and Training (National Hospital Organization, Kasumigaura Medical Center), Tsuchiura, Ibaraki Prefecture, Japan
| | - Shinobu Imai
- 3 Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization, Meguro-ku, Tokyo, Japan
| | - Masaya Nakadera
- 3 Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization, Meguro-ku, Tokyo, Japan
| | - Yukiko Wagatsuma
- 1 University of Tsukuba, Tsukuba, Ibaraki, Japan.,4 Faculty of Medicine, Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiromasa Horiguchi
- 3 Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization, Meguro-ku, Tokyo, Japan
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16
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Fisher A, Fisher L, Srikusalanukul W, Smith PN. Bone Turnover Status: Classification Model and Clinical Implications. Int J Med Sci 2018; 15:323-338. [PMID: 29511368 PMCID: PMC5835703 DOI: 10.7150/ijms.22747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness. Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures. Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days. Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.,Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.,Australian National University Medical School, Canberra, ACT, Australia
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia
| | - Paul N Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.,Australian National University Medical School, Canberra, ACT, Australia
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17
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Miyake H, Kanazawa I, Sugimoto T. Association of Bone Mineral Density, Bone Turnover Markers, and Vertebral Fractures with All-Cause Mortality in Type 2 Diabetes Mellitus. Calcif Tissue Int 2018; 102:1-13. [PMID: 28965188 DOI: 10.1007/s00223-017-0324-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/05/2017] [Indexed: 01/01/2023]
Abstract
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fragility fracture. However, the association between diabetes-related osteoporosis and mortality in T2DM remains unknown. This historical cohort study assessed the endpoint of all-cause mortality in patients with T2DM. According to our hospital record, bone parameters were examined in 797 patients from 1997 to 2009. We excluded 78 because of diseases affecting bone metabolism and could not follow-up 308 patients. Finally, in 411 patients, the associations of bone turnover markers, bone mineral density (BMD), and the prevalence of vertebral fractures with mortality were investigated by Cox regression analyses adjusted for confounding factors. Of 411 patients, 56 died during the follow-up period of almost 7 years. Cox regression analyses showed that reduced BMD at the lumbar spine (LS) and femoral neck (FN) (T-score ≤ -2.5) and severe vertebral fractures were associated with higher mortality (hazard ratio [HR] 3.25, 95% confidence interval [CI] 1.48-7.16, p = 0.003 for LS-T score ≤ -2.5; HR 5.19, 95% CI 1.83-14.75, p = 0.002 for FN-T score ≤ -2.5; HR 2.93, 95% CI 1.42-6.02, p = 0.004 for multiple vertebral fractures; HR 7.64, 95% CI 2.13-27.42, p = 0.002 for grade 3 vertebral fracture). Separate analysis in men and women showed that decreased serum osteocalcin was associated with mortality in women (HR 3.82, 95% CI 1.01-14.46 per SD decrease, p = 0.048). The present study is the first to show the association of reduced BMD and severe vertebral fractures with increased all-cause mortality in patients with T2DM. Moreover, higher serum osteocalcin was significantly associated with decreased mortality in women with T2DM.
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Affiliation(s)
- Hitomi Miyake
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Ippei Kanazawa
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan.
| | - Toshitsugu Sugimoto
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan
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18
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Gulin T, Kruljac I, Kirigin Biloš LS, Gulin M, Grgurević M, Borojević M. The role of adipokines as prognostic factors of one-year mortality in hip fracture patients. Osteoporos Int 2017; 28:2475-2483. [PMID: 28501890 DOI: 10.1007/s00198-017-4068-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 04/26/2017] [Indexed: 02/08/2023]
Abstract
UNLABELLED This study investigated the impact of anthropometric parameters, adiponectin, leptin, homeostatic model assessment for insulin resistance (HOMA-IR), beta-isomerised C-terminal telopeptide of collagen type I (β-CTX), and routine biochemical tests on one-year mortality in hip fracture patients. We found that male patients with high adiponectin, leptin, and β-CTX levels had a 5-fold increase in all-cause one-year mortality. INTRODUCTION Several predictors of one-year hip fracture mortality have been identified including advanced age, male sex, low bone mineral density, and preexisting comorbidities. However, the impact of metabolic parameters on hip fracture mortality remains unknown. The aim of this study was to examine the effect of serum leptin and adiponectin levels, as well as other metabolic parameters on all-cause one-year hip fracture mortality. METHODS This prospective study included 236 patients of all ages with non-traumatic hip fractures. Anthropometric parameters, adiponectin, leptin, HOMA-IR, β-CTX, and routine biochemical tests were recorded at admission and correlated with one-year mortality by using multivariate Cox proportional hazard models. RESULTS The median patient age was 82 (75-87) years, and one-year mortality rate was 28.4%. In univariate analysis, adiponectin, age, β-CTX, and renal function were associated with mortality. However, in a multivariate model, male gender, high β-CTX, adiponectin, and leptin were independently associated with increased mortality. Thus, we constructed a nomogram that included all the latter variables in addition to age. The nomogram predicted mortality with a sensitivity of 74.8% (66.0-82.3) and specificity of 74.4% (57.9-87.0), and had an area under the curve of 0.784. Patients that scored <9.2 had a mortality of 10.1%, while those with >9.2 had a mortality of 49.2% (relative risk 5.4, 95% CI 2.8-10.2, P < 0.001). CONCLUSION Male patients with high adiponectin, leptin, and β-CTX levels have a 5-fold increase in all-cause one-year mortality after hip fracture.
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Affiliation(s)
- T Gulin
- Department of Nephrology and Dialysis, University Hospital Center "Sestre Milosrdnice", University of Zagreb Medical School, 10000, Zagreb, Croatia.
| | - I Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital Center "Sestre Milosrdnice", University of Zagreb Medical School, 10000, Zagreb, Croatia
| | - L S Kirigin Biloš
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital Center "Sestre Milosrdnice", University of Zagreb Medical School, 10000, Zagreb, Croatia
| | - M Gulin
- Department of Diagnostic and Interventional Radiology, University Hospital Center "Sestre Milosrdnice", 10000, Zagreb, Croatia
| | - M Grgurević
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000, Zagreb, Croatia
| | - M Borojević
- Departmet for Cardiac Surgery, Clinical Hospital Center, 10000, Zagreb, Croatia
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