Title : Impact of age and gender in stratification risk outcomes in patients with HF
Abstract:
Background: Prognostication of osteoporotic hip fracture (HF) outcomes remains a challenge. There is a noticeable gap in the literature concerning the impact of age and gender, two fundamental biological and clinical characteristics, in preoperative prediction and management of adverse outcomes in patients with HF. In different patients, ageing develops at different rates, chronological age may differ from biological health and the gap varies in different organ systems.
Aim: Given that the age gap for individuals with different ages might represent different ageing levels we evaluated the association of chronological and biological (general and bone-specific) age and gender with fracture type (cervical and trochanteric) and adverse/fatal in-hospital outcomes.
Materials and Methods: We analysed prospectively collected data on 3784 patients (median age 84 years [interquartile range 11 years]; 2816 females [74.4%]) with an osteoporotic hip fracture. Patients were divided into groups: <70 years, 70-80 years and >80 years (chronological age). Biological age (general and bone-specific) was estimated using and laboratory (5 different for each) parameters. Age gap was calculated by subtracting chronological age from biological age. Outcomes included all-cause in-hospital mortality, high inflammatory response (C-reactive protein [CRP)]>150mg/L after the third postoperative day), myocardial injury (defined as cardiac troponin l [cTnI] rise) and prolonged length of stay (>20 days). Routine statistical analyses and machine learning (for biological age) techniques were employed.
Results: HF patients aged <70 years (9.5% of the total cohort), compared to other age groups, demonstrated the lowest mortality rates (1.4% among females, 0.69% among males), a lower incidence of postoperative myocardial injury (22.0% and 20.4%, respectively), high inflammatory response (50.5% and 54.1%) , and LOS>20 days (14.6% and 20.0%), but the highest age gap in the general (14 [5] years in females and 13 [5] years in males) and skeletal (21 [4] years and 18 [4] years, respectively) health. Each year of age gap elevation increased the mortality rate by 37% (OR 1.37, 95%CI 1.03-1.83, p=0.32). The differences between females and males include the higher prevalence of males (15.0% vs. 7.6%, p<0.001) and trochanteric fracture type in males (51.0% vs. 38.0%, p=0.020). In the oldest group (>80 years, 68.7 % of the total cohort), compared to the youngest one, the mortality rate was 4.2-14.1-times (among females and males, respectively) higher, the incidence of myocardial injury 4.0-4.9- times higher, the incidence of high inflammatory response 1.5-1.4-times higher, and the incidence of prolonged LOS was 1.8-1.4- times higher in females and males, respectively, but there was no age gap for both general and skeletal health. In the oldest group there was a significant prevalence of females (72.4% vs. 58.1%, p<0.001), and a markedly higher mortality rate among males (8.9% vs. 5.6%, p=0.007), while other adverse outcomes were not gender related.
Conclusions: In HF patients, fracture type and adverse outcomes are age- and gender- related with the worst among those aged >80 years, in whom the mortality rate is 4.2 (for females) -14.1 (for males) times higher than in <70-year-old. The youngest group demonstrates the highest gap between biological and chronological age.
