Hélène Vallet1,2, Camille Chenevier-Gobeaux3, Cédric Villain1, Judith Cohen-Bittan1, Patrick Ray2,4, Loïc Epelboin5, Marc Verny1,2,6, Bruno Riou2,7,8, Frédéric Khiami2,9, Jacques Boddaert1,2,6. 1. Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France. 2. Sorbonne Universités, UPMC Paris 6, Paris, France. 3. Clinical Chemistry Laboratory, Hôpitaux Universitaires Paris Centre (HUPC), APHP, Paris, France. 4. Department of Emergency Medicine, Groupe Hospitalo-Universitaire de l'Est parisien, site Tenon, APHP, Paris, France. 5. Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Université de la Guyane, Institut Pasteur de La Guyane et Centre d'Investigation Clinique CIC Antilles-Guyane Inserm 1424, Guyane Française, France. 6. UMR CNRS 8256, Paris, France. 7. Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France. 8. UMR INSERM 1166, IHU ICAN, Paris, France. 9. Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France.
Abstract
Background: Orthopedic surgery is more and more frequent in the older patients and is associated with a high mortality rate. Although serum procalcitonin levels are associated with prognosis in young adults, data are still lacking in the elderly population, and especially after surgery. The main objective of this study was to determine the prognostic value of procalcitonin levels in a large geriatric orthopedic population, and we compared it with clinical variables and biomarkers. Methods: This is a prospective study including patients admitted in our dedicated geriatric postoperative unit, after orthopedic surgery with immediate postoperative measured procalcitonin levels. Collected data included age, sex, medical history, functional status (activities of daily living [ADL]), fracture type, Cumulative Illness Rating scale (CIRS), postoperative complications, and biological data. The primary endpoint was the 30-day mortality. Results: 436 patients (age 85±6 years) were included. Hip fracture surgery was the most frequent (n = 310; 71%), and the 30-day mortality rate was 6.9%. Compared with C-reactive protein (CRP), albumin, CIRS, and ADL, procalcitonin had the highest area under the receiver operating characteristic curve for predicting 30-day mortality (0.74; 95% CI: 0.70-0.78). Using a cutoff at 1 µg/L, procalcitonin was more specific than CIRS to predict 30-day mortality (92 vs 77%; p < .001). In a multivariable analysis, procalcitonin level higher than 0.39 µg/L is a significant predictor of mortality within 30 days (odds ratio 3.84; 95% CI: 1.61-9.14, p = .002). Conclusion: Elevated procalcitonin values were strongly and significantly associated with mortality within 30 days in older patients after orthopedic surgery.
Background: Orthopedic surgery is more and more frequent in the older patients and is associated with a high mortality rate. Although serum procalcitonin levels are associated with prognosis in young adults, data are still lacking in the elderly population, and especially after surgery. The main objective of this study was to determine the prognostic value of procalcitonin levels in a large geriatric orthopedic population, and we compared it with clinical variables and biomarkers. Methods: This is a prospective study including patients admitted in our dedicated geriatric postoperative unit, after orthopedic surgery with immediate postoperative measured procalcitonin levels. Collected data included age, sex, medical history, functional status (activities of daily living [ADL]), fracture type, Cumulative Illness Rating scale (CIRS), postoperative complications, and biological data. The primary endpoint was the 30-day mortality. Results: 436 patients (age 85±6 years) were included. Hip fracture surgery was the most frequent (n = 310; 71%), and the 30-day mortality rate was 6.9%. Compared with C-reactive protein (CRP), albumin, CIRS, and ADL, procalcitonin had the highest area under the receiver operating characteristic curve for predicting 30-day mortality (0.74; 95% CI: 0.70-0.78). Using a cutoff at 1 µg/L, procalcitonin was more specific than CIRS to predict 30-day mortality (92 vs 77%; p < .001). In a multivariable analysis, procalcitonin level higher than 0.39 µg/L is a significant predictor of mortality within 30 days (odds ratio 3.84; 95% CI: 1.61-9.14, p = .002). Conclusion: Elevated procalcitonin values were strongly and significantly associated with mortality within 30 days in older patients after orthopedic surgery.
Authors: Lorène Zerah; David Hajage; Mathieu Raux; Judith Cohen-Bittan; Anthony Mézière; Frédéric Khiami; Yannick Le Manach; Bruno Riou; Jacques Boddaert Journal: J Clin Med Date: 2020-07-24 Impact factor: 4.241