COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels?

Kwan Hung Moya Tsui; Wai Wang Chau; Wing Hong Liu; Cheuk Yin Tam; Dennis King Hang Yee; Chi Yin Tso; Ning Zhang; Wing-Hoi Cheung; Ning Tang; Ronald Man Yeung Wong

doi:10.1016/j.jot.2023.09.008

COVID-19 hip fracture outcomes: The role of Ct values and D-dimer levels?

J Orthop Translat. 2023 Oct 23:43:14-20. doi: 10.1016/j.jot.2023.09.008. eCollection 2023 Nov.

Affiliations

¹ Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China.
² Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China.
³ Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.

Abstract

Introduction: The COVID-19 pandemic has caused high mortality rates in hip fracture patients, but data for Asian patients are lacking. Whilst Cycle threshold (Ct) values and D-dimer have been reported as predictors of mortality in COVID-19 patients, their prognostic roles in those with concomitant hip fracture remain unknown. The objectives of this study were to i) assess the clinical outcomes of COVID-19 hip fractures patients in the Chinese population, ii) identify risk factors of mortality and complications, and iii) determine the prognostic roles of Ct values and D-dimer levels.

Methodology: This cohort study was conducted during the 5th wave of the COVID-19 pandemic. Inclusion criteria were 1) hip fracture 2) ≥ 60 years old 3) low-energy trauma. Outcomes were 90-day all-cause mortality, complications, length of stay, discharge destination and mobility status. Logistic regression analysis was performed to identify risk factors for mortality and complications. Subgroup analysis was performed for patients with Ct < 30 and Ct > 30, comparing their outcomes of operations performed within 48 h vs beyond 48 h.

Results: 159 hip fracture patients were included, 42 patients were COVID-19 positive. COVID-19 group had significantly higher 90-day mortality rates (21.4% vs 9.4%), complication rates (45.2% vs 28.2%) and longer length of stay (17.06 vs 10.84 nights). COVID-19 was an independent risk factor for mortality and complications. Amongst the COVID-19 group, risk factors for poor outcomes were advanced age, steroids use, conservative treatment and American Society of Anaesthesiologists (ASA) score ≥ 3. Conservative treatment was associated with higher mortality (OR = 16.00; p = 0.025) in COVID-19 hip fracture patients. There was no significant difference between Ct values < 30 and >30 regarding mortality and complication rate. D-dimer and timing to operation did not affect outcomes.

Conclusions: Patients with concomitant COVID-19 and hip fracture are at high risk of mortality and complications. Ct values and D-dimer levels have no prognostic roles for hip fracture outcomes. Early operative treatment is recommended as soon as patients are medically fit.

Keywords: COVID-19; Ct value; D-dimer; Hip fracture; Mortality.