Prognostic Value Of Abnormal Serum Renal Function For Predicting Early Mortality Risk In Brittle Hip Fracture

Objective:To study the effect of renal function on the early all-cause mortality and it’s predictive value to early mortality risk in the patients with brittle hip fracture.Methods: In the retrospective study, we reviewed the clinical data of 231 patients admitted with brittle hip fracture from 2010 to 2012 who were followed up over 1 year, including pre-injury medical complication, routine blood tests and urine routine on admission and the 6-month and 1-year all-cause mortality.The effects of different genders on prevalence of abnormal serum renal function and routine urine were analyzed. The relation between pre-injury medical complication and admitted serum renal function and abnormal urine routine was analyzed. The relation of admitted serum renal function and abnormal urine routine on 6-month and 1-year all-cause mortality was analyzed. The effect of serum renal function and abnormal urine routine on the early mortality of brittle hip fracture was studied, and their predictive value to early mortality risk were assessed.Results: 170 of 231 patients suffered from pre-injury internal basic diseases, mostly including 4 kinds as cardiovascular diseases(77.65%), nervous system diseases(24.71%), diabetes(20.00%) and chronic respiratory diseases(17.65%); 56 and 114 patients respectively with 1 and over 2 pre-injury internal basic diseases; 27 patients with abnormal serum renal function; 3 patients with separate Scr >135umol/L,17 patients with BUN >7.5mmol/L, and 7 patients with both abnormity above.The prevalence of male and female was 14.94% and 9.72% respectively(P=0.291). 76 patients were abnormal in urine routine, 31 of them with urine protein(+), 2 with urinary cylinder >2/ul, and 61 with urinary red blood cell >18/ul.The prevalence of male and female was 24.14% and 38.19% respectively with female significantly higher than male(p=0.031).The quantity of pre-injury medical complication was associated with the prevalence of admitted abnormal serum renal function(p<0.05) and was independent of abnormal urine routine(p=0.676). The 6-month and 1-year all-cause mortality after hip fracture was respectively 13.41% with 31 patients dead and 16.01% with 37 dead. Through single factor analysis, abnormal serum renal function was a risk to early mortality of brittle hip fracture with the mortality in 6-month 3.314 times of normal(OR=3.314,95%CI=1.303-8.424, p=0.012), and in1-year 3.143 times of normal(OR=3.143,95%CI=1.285-7.684,p=0.012). When Scr > 135 umol/L, the death sensitivity in 6-month and 1-year was respectively 12.90% and 13.51%, and the specificity respectively 97.00% and 97.42%. When BUN >7.5mmol/L, the death sensitivity in 6-month and 1-year was respectively 22.58% and 21.62%, and the specificity respectively 91.50% and 91.75%.The abnormal urine routine was independent to early mortality in brittle hip fracture.Conclusion:The admitted abnormal serum renal function was associated with the raised all-cause mortality of brittle hip fracture in 6-month and 1-year and had predictive value to early mortality risk with high specificity in the patients with brittle hip fracture. The admitted abnormal urine routine was unrelated to the early all-cause mortality in brittle hip fracture.