Parsiyel protez ile tedavi edilen kalça kırıklı hastalarda kırmızı kan hücre dağılım genişliği ve mortalite ilişkisi

Öz

Amaç: Bu çalışmada parsiyel kalça protezi uygulanan hastalarda kırmızı kan hücre dağılım genişliği (RDW) ile mortalite arasındaki ilişkinin incelenmesi amaçlandı.

Çalışma planı: Kalça kırığı nedeni ile ameliyat edilen ve en az bir yıllık takibi bulunan 316 hasta (183 kadın, 133 erkek) değerlendirildi. Erkek hastaların yaş ortalaması 77.50 (65–95), kadın hastaların yaş ortalaması 78.23 (65–100) idi. Hastaların hastaneye başvurdukları zaman alınan kan tetkiklerindeki RDW düzeyleri ile mortalite arasındaki ilişki değerlendirildi.

Bulgular: Çalışmamızda yaş, trokanterik kırık ve yüksek (>14.5) RDW düzeyleri ile mortalite arasında anlamlı ilişki tespit edilmiştir. Bu üç faktörün bir arada olduğu hastalarda mortalite oranı diğer hastalara göre 2.8 kat yüksek bulunmuştur.

Çıkarımlar: RDW rutin kan tetkiklerinde bulunan bir parametredir. Kalça kırıklarının tedavisinin planlanması ve ameliyat sonrası mortalite oranlarının tahmininde kullanılan skorlama sistemlerinde yer alması gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• Kalça kırığı; kırmızı kan hücre dağılım genişliği (RDW); mortalite.

Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis

Abstract

Objective: This study aimed to determine the relationship between red cell distribution width (RDW) and mortality in patients that received a partial hip prosthesis.

Methods: The study included 316 patients (183 female and 133 male) that underwent surgery due to hip fracture and were followed up for ≥1 year. Mean age of the male and female patients was 77.50 years (range; 65–95) and 78.23 years (range; 65–100), respectively. The relationship between the RDW level at the time of presentation and mortality was evaluated.

Results: There was a significant relationship between mortality, and age (median age for man 77.50 and for woman 78.23) trochanteric fracture, and a high RDW level (>14.5%). In patients with these 3 characteristics the mortality rate was 2.8–fold higher than in the other patients.

Conclusion: RDW is a parameter measured via routine blood testing. We think that RDW measurement should be used in the planning of the treatment of hip fractures and in scoring systems used to estimate post–operative mortality.

Keywords

• Hip fracture
• red cell distribution width (RDW)
• mortality

Kaynakça

1. Sener M, Onar V, Kazlmoğlu C, Yağdi S. Mortality and morbidity in elderly patients who underwent partial pros- thesis replacement for proximal femoral fractures. [Article in Turkish] Eklem Hastalik Cerrahisi 2009;20:11-7.
2. A treatise on dislocationa and on fractures of the joints: fractures of the neck of the thigh-bone. Sir Astley Cooper, BART., F.R.S., Surgeon to the King. Clin Orthop Relat Res 1973;92:3-5. CrossRef
3. Vidán M, Serra JA, Moreno C, Riquelme G, Ortiz J. Ef- ficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, con- trolled trial. J Am Geriatr Soc 2005;53:1476-82. CrossRef
4. Wehren LE, Magaziner J. Hip fracture: risk factors and outcomes. Curr Osteoporos Rep 2003;1:78-85. CrossRef
5. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 1984;186:45-56.
6. Means RT Jr. Free and easy? Red cell distribution width (RDW) and prognosis in cardiac disease. J Card Fail 2011;17:299-300. CrossRef
7. Lappé JM, Horne BD, Shah SH, May HT, Muhlestein JB, Lappé DL, et al. Red cell distribution width, C-reac- tive protein, the complete blood count, and mortality in patients with coronary disease and a normal comparison population. Clin Chim Acta 2011;412:2094-9. CrossRef
8. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, et al. Usefulness of admission red cell distribu- tion width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012;109:128- 34. CrossRef

9. Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009;169:515-23. CrossRef
10. Crenshaw AH Jr. Surgical techniques and approaches. In: Canale ST, Beaty JH, editors. Campbell’s operative or- thopaedics. Vol 1. 11th ed. Philadelphia: Mosby; 2003. p. 3-122.
11. Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epi- demiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178-208.
12. Pande I, Scott DL, O’Neill TW, Pritchard C, Woolf AD, Davis MJ. Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis 2006;65:87-92. CrossRef
13. Brossa Torruella A, Tobias Ferrer J, Zorrilla Ribeiro J, López Borras E, Alabart Teixidó A, Belmonte Garridof M. Mortality after hip fracture: a three year follow-up study. [Article in Spanish] Med Clin (Barc) 2005;124:53- 4. [Abstract] CrossRef
14. Jalovaara P, Virkkunen H. Quality of life after primary hemiarthroplasty for femoral neck fracture. 6-year follow- up of 185 patients. Acta Orthop Scand 1991;62:208-17.
15. Foss NB, Kehlet H. Mortality analysis in hip fracture pa- tients: implications for design of future outcome trials. Br J Anaesth 2005;94:24-9. CrossRef
16. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of co- morbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observa- tional cohort study. BMJ 2005;331:1374. CrossRef
17. McLeod K, Brodie MP, Fahey PP, Gray RA. Long-term survival of surgically treated hip fracture in an Australian regional hospital. Anaesth Intensive Care 2005;33:749- 55.
18. Franzo A, Francescutti C, Simon G. Risk factors correlat- ed with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epide- miol 2005;20:985-91. CrossRef
19. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortal- ity. J Orthop Trauma 1997;11:162-5. CrossRef
20. Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mor- tality in patients with hip fractures. J Bone Miner Res 2005;20:494-500. CrossRef
21. Alegre-López J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernández-Melón J. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int 2005;16:729-36. CrossRef
22. Oztürk I, Toker S, Ertürer E, Aksoy B, Seçkin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. [Article in Turkish] Acta Orthop Traumatol Turc 2008;42:16-21.
23. Barangan JD. Factors that influence recovery from hip fracture during hospitalization. Orthop Nurs 1990;9:19- 30. CrossRef
24. Mossey JM, Mutran E, Knott K, Craik R. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health 1989;79:279-86.
25. Hedlund R, Lindgren U, Ahlbom A. Age- and sex-spe- cific incidence of femoral neck and trochanteric fractures. An analysis based on 20,538 fractures in Stockholm County, Sweden, 1972-1981. Clin Orthop Relat Res 1987;222:132-9.
26. Pérez-Martín A, Horrillo-Sánchez de Ocaña L, Satué- Bartolomé JA, Belinchón Paraíso JC, Gonzalo-Pascua S, Marrero-Francés J, et al. Red cell distribution width and mortality following hospital discharge in patients over 70 years of age. Med Clin (Barc). 2013 Jul 25. [Epub ahead of print]
27. Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, et al. Red cell distribution width and mortal- ity in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci 2010;65:258-65. CrossRef
28. Hunziker S, Stevens J, Howell MD. Red cell distribution width and mortality in newly hospitalized patients. Am J Med 2012;125:283-91. CrossRef
29. Şenol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med 2013;31:687-9. CrossRef
30. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013;31:545- 8. CrossRef
31. Braun E, Domany E, Kenig Y, Mazor Y, Makhoul BF, Azzam ZS. Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia. Crit Care 2011;15:R194. CrossRef
32. Zalawadiya SK, Zmily H, Farah J, Daifallah S, Ali O, Ghali JK. Red cell distribution width and mortality in predominantly African-American population with de- compensated heart failure. J Card Fail 2011;17:292-8. CrossRef
33. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMur- ray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007;50:40-7. CrossRef
34. Ye Z, Smith C, Kullo IJ. Usefulness of red cell distribu- tion width to predict mortality in patients with peripheral artery disease. Am J Cardiol 2011;107:1241-5. CrossRef