• Humans
• Hip Fractures/surgery
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Female
• Aged
• Male
• Aged, 80 and over
• Risk Factors
• Nomograms
• Risk Assessment/methods
• ROC Curve
• C-Reactive Protein/metabolism
• C-Reactive Protein/analysis

• Postoperative delirium
• independent risk factor
• intracranial atherosclerotic stenosis
• nomogram
• percutaneous transluminal angioplasty and stenting

• Fracture
• Hip function
• Inflammatory factors
• Prevention
• Risk factors

• arthroplasty
• complications
• femoral neck fracture
• readmission
• time to surgery

• Humans
• Arthroplasty, Replacement, Hip/adverse effects
• Retrospective Studies
• Cohort Studies
• Hospital Mortality
• Pulmonary Embolism
• Femoral Neck Fractures/surgery

• C-reactive protein
• albumin
• arthroplasty
• early mortality
• elderly patients
• femoral fractures
• femoral nailing
• intramedullary nail
• total hip arthroplasty

• Parkinson’s disease
• biomarker
• cerebrospinal fluid
• deep brain stimulation
• postoperative delirium

• antibiotics impregnated
• calcium sulfate
• chronic calcaneal osteomyelitis
• fracture-related infection
• irrigation-suction

Background

Orthopedic fracture-associated infection is a prevalent complication with a huge burden on the healthcare infrastructure. C-reactive protein (CRP) is a widely used serum inflammatory marker in patients with infections in orthopaedics. It could be difficult to distinguish between CRP elevation caused by surgical site infection and CRP elevation caused by surgery and trauma in orthopaedic procedures. In most situations, a clinical diagnosis of post-surgical infection is sufficient, however, the use of a biomarker with predictive value for acute post-op complications could prompt an earlier diagnosis. This study, therefore, aims at assessing CRP levels in post-operative orthopaedic trauma patients and determining the reliability of CRP as an early indicator of postoperative infection.

Materials and methods

A prospective study was conducted between December 2020 and November 2021 in the department of orthopaedics in Sri Devaraj Urs medical college, Kolar. Patients with an open and closed fracture of the upper and lower extremities treated by osteosynthesis on an elective or emergency basis were included. The clinical parameters were studied on the day of trauma, postoperative days first, third and seventh. Blood samples for CRP were taken prior to the surgical procedure and on the same days as clinical monitoring. The CRP levels were compared between patients with postoperative infection and patients without postoperative infections using independent samples t-test. A p-value of < 0.05 was considered statistically significant.

Results

A total of 51 patients were included in the study meeting the inclusion criteria, of which mean standard deviation for age was 37.5 (15.7%), 44 were men (86.2%) and seven were women (13.7%), Patients according to Tscherene classification grade I were 10 (19.6%), grade II were eight (15.6%), grade III were 15 (29.4%) and grade IV was 18 (35.2%), type of fracture surgery diaphyseal were 27 (52.9%), proximal was 11 (21.5%) and distal were 13 (25.4%). 15 patients developed postoperative infection with CRP levels of 96 µg/mL in nine (17.6%), 48 µg/mL in four (7.8%) and 24 µg/mL in two (3.9%). Thirty-six patients who did not develop post-operative infection had CRP levels of 6 µg/mL in 31 (60.8%) and 12 µg/mL in five (9.8%). The p-value for the first postoperative day was 0.289 and statistically insignificant and on the third and seventh postoperative days was <0.001 and was found to be statistically significant.

Conclusion

C-reactive protein is a useful parameter to detect and monitor post-operative infections in orthopaedic trauma surgeries. The rise in C-reactive protein on the third and seventh postoperative days can be used as a reliable predictor of post-operative infections.

The main purpose of this study is to evaluate prognostic factors that affected the patients' early (<30 days) and late (six months, one year, and overall) postoperative mortality following hip fracture surgery.

This retrospective study included 515 patients older than 75 years old with surgically treated osteoporotic hip fracture. The demographic data, American Society of Anesthesiologists (ASA) classification, type of anesthesia, duration of hospital stay, and history of intensive care unit (ICU) stay were collected. An analysis of laboratory values was also performed to determine their relationship with mortality. The primary outcome was survival, determined as the time from the surgery to death or the end of the study. The patients were divided into four groups according to survival time: at the first month, six months, first year, and overall survival. An analysis of demographic and laboratory values was performed to determine their validity as prognostic factors for each group.

Postoperative C-reactive protein (CRP) level showed an independent association with a poor survival at the first month. ASA classification, admission to the ICU, and preoperative CRP levels showed an independent association with a poor survival for the first six months. Preoperative CRP level showed an independent association with a poor survival for the first year. ASA classification, admission to the ICU, and the preoperative CRP levels showed an independent association with a poor overall survival.

CRP level, a high ASA classification, and postoperative ICU admission were related to poorer overall survival rate following hip fracture surgery in the elderly.

• Cause of death
• Elderly
• Geriatric fracture
• Hip fractures
• Mortality

• complication
• inflammatory markers
• periprosthetic fracture
• periprosthetic joint infection
• total joint arthroplasty

• Arthroplasty, Replacement, Hip/adverse effects
• Biomarkers
• Blood Sedimentation
• C-Reactive Protein/analysis
• Humans
• Periprosthetic Fractures/diagnosis
• Periprosthetic Fractures/etiology
• Prosthesis-Related Infections/diagnosis
• Prosthesis-Related Infections/surgery
• Reproducibility of Results
• Sensitivity and Specificity
• Synovial Fluid/chemistry

COVID-19 has resulted in a pandemic after its first appearance in a pneumonia patient in China in early December 2019. As per WHO, this global outbreak of novel COVID-19 has resulted in 28,329,790 laboratory-confirmed cases and 911,877 deaths which have been reported from 210 countries as on 12^th Sep 2020. The major symptoms at the beginning of COVID-19 are fever (98%), tussis (76%), sore throat (17%), rhinorrhea (2%), chest pain (2%), and myalgia or fatigue (44%). Furthermore, acute respiratory distress syndrome (61.1%), cardiac dysrhythmia (44.4%), shock (30.6%), hemoptysis (5%), stroke (5%), acute cardiac injury (12%), acute kidney injury (36.6%), dermatological symptoms with maculopapular exanthema (36.1%), and death can occur in severe cases. Even though human coronavirus (CoV) is mainly responsible for the infections of the respiratory tract, some studies have shown CoV (in case of Severe Acute Respiratory Syndrome, SARS and Middle East Respiratory Syndrome, MERS) to possess potential to spread to extra-pulmonary organs including the nervous system as well as gastrointestinal tract (GIT). Patients infected with COVID-19 have also shown symptoms associated with neurological and enteric infection like disorders related to smell/taste, loss of appetite, nausea, emesis, diarrhea, and pain in the abdomen. In the present review, we attempt to evaluate the understanding of basic mechanisms involved in clinical manifestations of COVID-19, mainly focusing on interaction of COVID-19 with gut-brain axis. This review combines both biological characteristics of the virus and its clinical manifestations in order to comprehend an insight into the fundamental potential mechanisms of COVID-19 virus infection, and thus endorse in the advancement of prophylactic and treatment strategies.

• ACE2 receptor
• COVID-19 infection
• SARS-CoV-2
• cytokine storm
• dysbiosis
• gut-brain axis
• microbiota

• Advanced cancer
• Biomarker
• Delirium
• Review

Introduction

The aim of the current study is to investigate the relationship between mortality rate in geriatric patients undergoing surgery with preoperative serum levels of procalcitonin, C-reactive protein, and erythrocyte sedimentation rate.

Methods

This was a single-center retrospective study, including three groups with 101 patients, who are older than 65 years of age. A retrospective investigation was carried out from the laboratory information system for all groups from January to December 2018. Group 1 included patients who had surgery and then mortality within 30 days after surgery. Group 2 included hospitalized patients who had surgery and no mortality within 30 days after surgery. Group 3 included outpatient patients, who had suspicion for a bacterial infection and then no surgery or no mortality within 30 days.

Results

When three group comparisons were made for procalcitonin, C-reactive protein, and erythrocyte sedimentation rate values, the p-value of one-way analysis of variance (ANOVA) was higher than 0.05 for procalcitonin and lower than 0.05 for C-reactive protein and erythrocyte sedimentation rate, suggesting that one or more groups were significantly different. When post-hoc multiple comparison methods were applied, there were statistically significant differences between Groups 1 and 3 for C-reactive protein and erythrocyte sedimentation rate.

Conclusions

Procalcitonin levels do not predict mortality following surgery. C-reactive protein and erythrocyte sedimentation rate are more useful biomarkers predicting mortality in geriatric patients undergoing surgery.

• geriatric medicine
• mortality
• procalcitonin
• surgery

• Bacterial
• C-reactive protein
• Differential diagnosis
• Infection
• Viral

• Hip fracture
• Inflammatory markers
• Mortality
• Prognosis

• Aged
• Aged, 80 and over
• Biomarkers/blood
• C-Reactive Protein/analysis
• Databases, Factual
• Denmark
• Female
• Ferritins/blood
• Hip Fractures/mortality
• Humans
• Male
• Proportional Hazards Models
• Receptors, Urokinase Plasminogen Activator/blood
• Retrospective Studies

Delirium after surgery and in the intensive care unit (ICU) remains a challenge for patients, families, and caregivers. Over the years, many promising biomarkers have been investigated as potential instruments for risk stratification of delirium. This review aimed to identify and assess the clinical usefulness of candidate serum biomarkers associated with hospital delirium in patients aged 60 years and older. We performed a time-unlimited review of publications indexed in PubMed, Cochrane, Embase, and MEDLINE databases until June 2019 that evaluated baseline and/or longitudinal biomarker measurements in patients suffering from delirium at some point during their hospital stay. A total of 32 studies were included in this review reporting information on 7610 patients. Of these 32 studies, twenty-four studies reported data from surgical patients including four studies in ICU cohorts, five studies reported data from medical patients (1026 patients), and three studies reported data from a mixed cohort (1086 patients), including one study in an ICU cohort. Findings confirm restricted clinical usefulness to predict or diagnose delirium due to limited evidence on which biomarkers can be used and limited availability due to non-routine use.

• Adolescent
• Adult
• Anti-Bacterial Agents/therapeutic use
• Calcium Sulfate/therapeutic use
• Debridement/methods
• External Fixators
• Female
• Fracture Fixation/methods
• Humans
• Male
• Middle Aged
• Osteogenesis, Distraction/methods
• Osteomyelitis/drug therapy
• Osteomyelitis/surgery
• Retrospective Studies
• Tibia/surgery
• Tibial Fractures/therapy
• Young Adult

• discharge abstracts
• episode of care
• hip fracture
• time to surgery

• Aged
• Canada
• Computational Biology/methods
• Databases as Topic
• Hip Fractures/mortality
• Hip Fractures/surgery
• Hospitalization
• Humans
• Retrospective Studies
• Time-to-Treatment

• CIHR
• Canadian Institutes of Health Research

• C-reactive protein
• Complication
• Intertrochanteric femoral fracture
• Postoperative systemic infection

This study aimed to determine the kinetics of four inflammatory markers and to identify the variables that affect the natural kinetics of inflammatory markers in aged patients having hip fractures with and without elevated preoperative CRP. 240 elderly patients who have been operated on for femoral neck fracture with no infectious complications were divided into two groups on elevated preoperative CRP level (>10 mg/L). The temporal values of four inflammatory markers of WBC, neutrophil count (N) (%), ESR, and CRP were assessed eight times every other day until the 14th postoperative day. At 48–60 h postoperatively, mean CRP was markedly higher in patients with preoperatively elevated CRP than in those with nonelevated CRP (122.1 ± 65.9 and 73.7 ± 35.5, p < 0.001). However, the abrupt elevation of CRP in the elevated group was conversely decreased on the 4th-5th postoperative day, demonstrating similar kinetic curves with no significant differences between both groups. For WBC, N (%), and ESR, both groups showed similar patterns of temporal values 14 days after surgery regardless of preoperative CRP level. Our findings could be used as guidelines for patient discharge and during the follow-up period after surgery.

The aim of this study was to summarize and discuss the similarities and differences in inflammatory biomarkers in postoperative delirium (POD) and cognitive dysfunction (POCD).

A systematic retrieval of literature up to June 2017 in PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure database, and the Wanfang database was conducted. Extracted data were analyzed with STATA (version 14). The standardized mean difference (SMD) and the 95% confidence interval (95% CI) of each indicator were calculated using a random effect model. We also performed tests of heterogeneity, sensitivity analysis, assessments of bias, and meta-regression in this meta-analysis.

A total of 54 observational studies were included. By meta-analysis we found significantly increased C-reactive protein (CRP) (9 studies, SMD 0.883, 95% CI 0.130 to 1.637, P = 0.022 in POD; 10 studies, SMD -0.133, 95% CI -0.512 to 0.246, P = 0.429 in POCD) and interleukin (IL)-6 (7 studies, SMD 0.386, 95% CI 0.054 to 0.717, P = 0.022 in POD; 16 studies, SMD 0.089, 95% CI -0.133 to 0.311, P = 0.433 in POCD) concentrations in both POD and POCD patients. We also found that the SMDs of CRP and IL-6 from POCD patients were positively correlated with surgery type in the meta-regression (CRP: Coefficient = 1.555365, P = 0.001, 10 studies; IL-6: Coefficient = -0.6455521, P = 0.086, 16 studies).

Available evidence from medium-to-high quality observational studies suggests that POD and POCD are indeed correlated with the concentration of peripheral and cerebrospinal fluid (CSF) inflammatory markers. Some of these markers, such as CRP and IL-6, play roles in both POD and POCD, while others are specific to either one of them.

• Biomarkers/metabolism
• Cognitive Dysfunction/metabolism
• Cognitive Dysfunction/physiopathology
• Delirium/metabolism
• Delirium/physiopathology
• Humans
• Inflammation/metabolism
• Observational Studies as Topic
• Postoperative Complications/metabolism
• Postoperative Complications/physiopathology

• Hip fracture
• Quantile regression
• Time to surgery
• Timing of admission
• Variation

• After-Hours Care/statistics & numerical data
• Aged
• Aged, 80 and over
• Canada
• Databases, Factual
• Female
• Hip Fractures/surgery
• Hospitalization/statistics & numerical data
• Humans
• Male
• Patient Admission/statistics & numerical data
• Time Factors
• Time-to-Treatment/statistics & numerical data

• MOP-133629 Institute of Health Services and Policy Research
• CIHR

• discharge abstracts
• hip fracture
• medical delays
• surgical fitness
• time to surgery

• Aged
• Aged, 80 and over
• Canada
• Databases, Factual
• Female
• Hip Fractures/surgery
• Hospitalization/statistics & numerical data
• Humans
• Male
• Medical Records/statistics & numerical data
• Risk Factors
• Time Factors
• Time-to-Treatment/statistics & numerical data
• Time-to-Treatment/trends

• Canadian Institutes of Health Research

• C-reactive protein
• delirium
• delirium feature severity
• inflammation
• postoperative

• C-reactive protein
• Case-control study
• Delirium
• Inflammation
• Postoperative
• Proteomics

• Aged
• Aged, 80 and over
• Biomarkers/blood
• C-Reactive Protein/metabolism
• Case-Control Studies
• Delirium/blood
• Delirium/diagnosis
• Elective Surgical Procedures
• Enzyme-Linked Immunosorbent Assay
• Female
• Humans
• Longitudinal Studies
• Male
• Postoperative Complications/blood
• Postoperative Complications/diagnosis
• Proteomics

• R01 AG051658 NIA NIH HHS
• R01 AG044518 NIA NIH HHS
• K24 AG035075 NIA NIH HHS
• K07 AG041835 NIA NIH HHS
• P01 AG031720 NIA NIH HHS
• T32 AG023480 NIA NIH HHS
• L30 AG048543 NIA NIH HHS
• R01 AG030618 NIA NIH HHS

• c-reactive protein
• hip fracture surgery
• 1-year mortality

• Aged
• Aged, 80 and over
• C-Reactive Protein/metabolism
• Female
• Follow-Up Studies
• Fracture Fixation
• Hip Fractures/blood
• Hip Fractures/mortality
• Hip Fractures/surgery
• Hospital Mortality/trends
• Humans
• Incidence
• Male
• Odds Ratio
• Postoperative Complications/epidemiology
• Prognosis
• Republic of Korea
• Retrospective Studies
• Risk Factors
• Survival Rate/trends

Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms.

• Confusion Assessment Method
• adult reconstructive surgery
• delirium
• geriatric medicine

• Hip fracture
• Mortality
• Patient factors
• Scoping review
• System factors

• Age Factors
• Aged
• Aged, 80 and over
• Cardiorespiratory Fitness/physiology
• Frail Elderly
• Glycemic Index/physiology
• Hip Fractures/diagnosis
• Hip Fractures/mortality
• Hip Fractures/physiopathology
• Humans
• Middle Aged
• Risk Factors

• Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute
• Centre for Hip Health and Mobility, University of British Columbia

• Clinical aspects
• Delirium
• Elderly hospitalized patients
• Risk factors

• POCD
• POD
• biomarker
• postoperative cognitive dysfunction
• postoperative delirium
• systems biology

• CRP
• DRS-R98-T
• Delirium
• IGF-1
• TNF-α

• C-reactive protein
• IL-6
• Inflammation
• Schizophrenia

The aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture.

Eighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient’s admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded.

Two patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture.

In conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture.

• Acute-Phase Proteins
• Aged
• Aged, 80 and over
• Biomarkers/blood
• C-Reactive Protein/metabolism
• Female
• Gait/physiology
• Hip Fractures/blood
• Hip Fractures/complications
• Hip Fractures/mortality
• Hip Fractures/surgery
• Humans
• Length of Stay
• Lipocalin-2
• Lipocalins/blood
• Male
• Matrix Metalloproteinase 2/blood
• Matrix Metalloproteinase 9/blood
• Pressure Ulcer/blood
• Pressure Ulcer/complications
• Pressure Ulcer/mortality
• Pressure Ulcer/surgery
• Prognosis
• Prospective Studies
• Protein Binding
• Proto-Oncogene Proteins/blood
• Recovery of Function/physiology
• Regression Analysis
• Survival Analysis
• Treatment Outcome

• Delirium
• Elderly
• Hip surgery
• K-DRS-98
• Prodromal