Different C-reactive protein kinetics in post-operative hip-fractured geriatric patients with and without complications
Different C-reactive protein kinetics in post-operative hip-fractured geriatric patients with and without complications
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DOI：
10.1159/000078350
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发表时间：
2004-01-01
期刊：
影响因子：
3.5
通讯作者：
Hendel, D
中科院分区：
文献类型：
--
作者：
Beloosesky, Y;Grinblat, J;Hendel, D
背景资料：髋部骨折是老年人常见的损伤，其功能损害、并发症和死亡率高。目的：测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，探讨这些参数与认知功能、手术类型、术后并发症、术后1个月功能水平和6个月死亡率的关系。方法和对象：对32例老年髋部骨折手术患者进行前瞻性随访6个月。记录骨折、手术类型和麻醉风险。认知功能采用简易精神状态检查量表评定，骨折前功能水平采用日常生活活动能力（ADL）的Katz指数评定。随访包括并发症、死亡率和功能结局。分别在骨折后10 h、术后48 - 60 h、术后7天和30天评估CRP、纤维蛋白原和ESR。结果如下：只有CRP动力学在有并发症的患者与无并发症的患者中存在差异（p = 0.006），在感染、谵妄和心血管并发症的患者与无并发症的患者中存在差异（分别为p = 0.06、0.03、0.02）。术后48 - 60小时，并发症患者和无并发症患者的平均（+/-BSEM）CRP分别为20.9 +/- 2.1和13.1 +/- 1.6 mg/dl（p = 0.002）。术后48 - 60 h的平均CRP与CRP曲线下面积高度相关，R = 0.88（p < 0.001）。术后48 - 60 h，CRP的截止值为15 mg/dl，计算出并发症患者（敏感性93%，特异性65%，p = 0.003）。CRP、纤维蛋白原和ESR与骨折或手术类型、认知、麻醉风险、术后1个月功能和6个月死亡率无关。结论：老年髋部骨折患者术后CRP测定对评估和监测并发症有一定的价值。版权所有（C）2004 S. Karger AG，巴塞尔。
Background: Hip fracture is a frequent injury in the elderly, and is associated with a high incidence of functional impairment, complications and mortality. Objective: 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. Methods and Subjects: 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. Results: 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 (+/-BSEM) CRP 48 - 60 h postoperatively 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. Conclusions: CRP measurement in elderly patients operated for hip fracture may be valuable in assessing and monitoring complications. Copyright (C) 2004 S. Karger AG, Basel.