Exploring the role of systemic inflammation in guiding clinical decision making for geriatric patients with a hip fracture

PURPOSE: Geriatric patients with a hip fracture are at risk for adverse outcomes after surgery. A pilot study showed the feasibility of assessing of systemic inflammation in these patients through neutrophil analysis. The aim of this study was to correlate neutrophil categories to clinical outcomes in a larger cohort.

METHODS: In this prospective cohort study, blood samples were taken from geriatric patients with a hip fracture directly after trauma and healthy older people serving as controls. Neutrophil phenotypes were categorized (0-6 from no inflammation to severe inflammation) and correlated to clinical outcomes.

RESULTS: In total, 289 patients (median age 82) and 45 age matched controls were included. Severe infections occurred in 8% of the patients and 9% died within 30 days. Patients displayed all neutrophil categories (0-6), while controls showed categories 0,1,3. A newly identified neutrophil category had higher leukocyte counts and CRP, with trends toward increased infections and mortality. Among patients receiving palliative care, 30-day mortality was 50% in categories 0-1 and 83% in higher categories.

CONCLUSION: Neutrophil categories offer a feasible method to assess systemic inflammation and may assist in shared decision-making for palliative care. The data are consistent with the hypothesis that patients in category 0-1 are deemed fit for surgery, when other risk factors are absent. However, further research should investigate the quality-of-life of patients still alive after 30 days in order to determine whether immune profiling is of added clinical value in decision making regarding traumatic hip fractures in geriatric patients.