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Novel biomarkers for prediction of outcome in hip fracture patients—An exploratory study

Jonsson, Magnus H. LU ; Hommel, Ami LU ; Todorova, Lizbet LU ; Melander, Olle LU and Bentzer, Peter LU (2020) In Acta Anaesthesiologica Scandinavica 64(7). p.920-927
Abstract

Background: Little is known about the value of biomarkers for prognostication in hip fracture patients. The main objective of the present study was to assess if biomarkers add useful information to an existing risk score for prediction of 30-day mortality in patients suffering from out of hospital hip fractures. Methods: In a prospective observational single centre study, association between plasma concentration of ninety-two biomarkers at admission and 30-day mortality was analysed using logistic regression adjusted for risk factors included in Nottingham Hip Fracture Score (NHFS). Biomarkers associated with the outcome in the adjusted analysis were further evaluated by calculating the net reclassification improvement (NRI) and the... (More)

Background: Little is known about the value of biomarkers for prognostication in hip fracture patients. The main objective of the present study was to assess if biomarkers add useful information to an existing risk score for prediction of 30-day mortality in patients suffering from out of hospital hip fractures. Methods: In a prospective observational single centre study, association between plasma concentration of ninety-two biomarkers at admission and 30-day mortality was analysed using logistic regression adjusted for risk factors included in Nottingham Hip Fracture Score (NHFS). Biomarkers associated with the outcome in the adjusted analysis were further evaluated by calculating the net reclassification improvement (NRI) and the change in area under the receiver operating characteristics curve (AUC) relative to the NHFS. Results: 997 patients were included. Sixty-two patients died within 30 days (6.2%). Eleven biomarkers were associated with 30-day mortality in adjusted analysis. Of these biomarkers Growth Differentiation Factor-15 (GDF-15) had NRI for the primary outcome (12.1%; 95% CI: 1.2-23.3) and Carbohydrate Antigen 125 (CA-125) improved the AUC relative to NHFS (improvement: 0.05; 95% CI: 0.01-0.10, P =.027). Both CA-125 and GDF-15 improved the AUC for a composite outcome of 30-day mortality and cardiovascular complications. Conclusions: Adding GDF-15 or CA-125 to the Nottingham Hip Fracture Score improves the discrimination with regard to predicting 30-day mortality and may help to identify a subgroup of hip fracture patients with a particularly poor prognosis. The value of these biomarkers should be explored in further studies to confirm clinical utility.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
biomarkers, CA-125, GDF-15, hip fractures, mortality, NHFS, prognostications
in
Acta Anaesthesiologica Scandinavica
volume
64
issue
7
pages
8 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:32236942
  • scopus:85083379552
ISSN
0001-5172
DOI
10.1111/aas.13581
language
English
LU publication?
yes
id
dbe142f8-33bd-4863-a43b-225fa7c51b50
date added to LUP
2020-04-30 14:41:06
date last changed
2021-07-13 04:59:31
@article{dbe142f8-33bd-4863-a43b-225fa7c51b50,
  abstract     = {<p>Background: Little is known about the value of biomarkers for prognostication in hip fracture patients. The main objective of the present study was to assess if biomarkers add useful information to an existing risk score for prediction of 30-day mortality in patients suffering from out of hospital hip fractures. Methods: In a prospective observational single centre study, association between plasma concentration of ninety-two biomarkers at admission and 30-day mortality was analysed using logistic regression adjusted for risk factors included in Nottingham Hip Fracture Score (NHFS). Biomarkers associated with the outcome in the adjusted analysis were further evaluated by calculating the net reclassification improvement (NRI) and the change in area under the receiver operating characteristics curve (AUC) relative to the NHFS. Results: 997 patients were included. Sixty-two patients died within 30 days (6.2%). Eleven biomarkers were associated with 30-day mortality in adjusted analysis. Of these biomarkers Growth Differentiation Factor-15 (GDF-15) had NRI for the primary outcome (12.1%; 95% CI: 1.2-23.3) and Carbohydrate Antigen 125 (CA-125) improved the AUC relative to NHFS (improvement: 0.05; 95% CI: 0.01-0.10, P =.027). Both CA-125 and GDF-15 improved the AUC for a composite outcome of 30-day mortality and cardiovascular complications. Conclusions: Adding GDF-15 or CA-125 to the Nottingham Hip Fracture Score improves the discrimination with regard to predicting 30-day mortality and may help to identify a subgroup of hip fracture patients with a particularly poor prognosis. The value of these biomarkers should be explored in further studies to confirm clinical utility.</p>},
  author       = {Jonsson, Magnus H. and Hommel, Ami and Todorova, Lizbet and Melander, Olle and Bentzer, Peter},
  issn         = {0001-5172},
  language     = {eng},
  number       = {7},
  pages        = {920--927},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Novel biomarkers for prediction of outcome in hip fracture patients—An exploratory study},
  url          = {http://dx.doi.org/10.1111/aas.13581},
  doi          = {10.1111/aas.13581},
  volume       = {64},
  year         = {2020},
}