Systemic inflammatory response following hip fracture in older people: postoperative CRP and PCT dynamics and their...

Hip fractures are a common condition in older people and still cause high personal and socioeconomic losses. Particularly, systemic inflammation is a risk factor for postoperative complications and mortality. Therefore, the aim of this study was to recognize factors that are associated with inflammation to identify patients at risk at an early stage. This retrospective observational study included patients with hip fractures over 70 years of age who presented to our surgical department between 2022 and 2023. Primary endpoints were maximum postoperative C-reactive protein (CRP_max) and procalcitonin (PCT_max) levels and independent variables were gender, age, time to surgery (TTS), type and duration of surgery as well as laboratory values preoperatively and up to five days postoperatively. 178 patients aged 70 to 102 years were included. Univariate analyses revealed correlations between CRP_max and TTS (r = 0.17, p = 0.02), duration of surgery (r = 0.46, p < 0.001), preoperative creatinine (r = 0.26, p < 0.001) and postoperatively, with creatinine (r = 0.30, p < 0.001), activated partial thromboplastin time (aPTT) (r = 0.61, p < 0.001) and International Normalized Ratio (INR) (r = 0.42, p = 0.002). Additionally, a significantly higher CRP_max was observed in patients treated with hemiarthroplasty compared with intramedullary nailing (p < 0.001), as well as in male patients (p = 0.008). Correlations were noticed for PCT_max with duration of surgery (r = 0.29, p < 0.001), preoperative creatinine (r = 0.19, p = 0.01) and postoperatively, with creatinine (r = 0.38, p < 0.001), aPTT (r = 0.49, p < 0.001) and platelets (r = -0.21, p = 0.007). Furthermore, a higher PCT_max (p = 0.01) were found in males. However, multivariate analyses could only confirm an independent relationship between CRP_max and PCT (p = 0,004) as well as aPTT (p = 0,029). The study demonstrated correlations of renal function and coagulation parameters with postoperative CRP_max and PCT_max values in older patients with hip fractures. Furthermore, implantation of a hemiarthroplasty, longer duration of surgery, longer TTS and male gender are associated with higher postoperative inflammation. These variables could indicate patients at risk and should lead to increased clinical surveillance. However, multivariate analyses could only identify correlations with coagulation and inflammation parameters, so further studies will be necessary to confirm the findings.