Resrospective analysis of patients diagnosed with proximal femur fracture in the emergency department and evaluation of factors affecting mortality

Introduction and Aim: Proximal femur fractures are a common occurrence, especially in the elderly population, often resulting from low-energy traumas. With the increasing aging population, the incidence of these fractures is also on the rise, making them a significant cause of mortality and morbidity worldwide. This study aimed to investigate the association of hematological and biochemical parameters with early and late mortality in patients with proximal femur fractures admitted to the emergency department of Afyonkarahisar Health Sciences University Faculty of Medicine Hospital. Materials and methods: This retrospective cohort study included 344 patients diagnosed with proximal femur fractures upon admission to the emergency department of Afyonkarahisar Health Sciences University Hospital between January 1, 2018 and July 1, 2023. Patient data were collected from the hospital's electronic medical record system and patient files. Demographic characteristics, fracture-related information and laboratory results obtained upon admission were recorded. Mortality data were ascertained during a one-year follow-up period, with early mortality defined as death within 30 days of admission and late mortality defined as death between 30 days and one year after admission.Laboratory parameters analyzed included hemoglobin, leukocyte count, neutrophil count, lymphocyte count, monocyte count, platelet count, red cell distribution width (RDW), glucose, potassium, C-reactive protein (CRP), albumin, and total protein. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), CRP-to-albumin ratio (CAR), and glucose-to-potassium ratio were calculated and recorded. Data were analyzed using SPSS 27 for Windows statistical software. Descriptive statistics were used to summarize patient characteristics and laboratory parameters. Univariate analysis was performed to identify associations between variables and early-late mortality. Findings: The study included 344 patients who met the inclusion criteria, with 205 (59.6%) females and 139 (40.4%) males. The mean age of the patients was 81.88 ± 7.76 years. By age group, 25 patients (7.3%) were between 65 and 74 years old, 113 patients (32.8%) were between 75 and 84 years old, and 206 patients (59.9%) were 85 years old or older. Fractures occurred in the right extremity in 53.2% of cases and in the left extremity in 46.8%. Extracapsular fractures (n=256, 74.4%) were more common than intracapsular fractures (n=88, 25.6%). Intensive care unit (ICU) admission was not required for 83.7% of the patients, while only 16.3% required ICU admission. The median length of hospital stay was 7 days (IQR=5-9), and the median ICU length of stay was 5 days (IQR=3-16). Early and late mortality rates were compared across age groups. While mortality was higher in older patients, the difference was not statistically significant. No association was found between fracture type and mortality. Admission hemoglobin levels were significantly different between patients who died early or late and those who survived for one year. RDW levels were also significantly different between patients who died early and those who survived for one year. No statistically significant relationships were found between mortality groups and NLR, PLR, MLR, and CAR values. Admission glucose-to-potassium ratios were significantly different between patients who died early and those who survived for one year. Result: The demographic and clinical characteristics of the study group were found to be compatible with the literature. It has been observed that there is a relationship between low Hb value and high RDW value at the time of admission to the hospital and the risk of mortality due to proximal femur fracture. Similarly, it has been determined that the high ratio of glucose and potassium values in the blood is associated with mortality, especially in the early period. Determining the etiologies of anemia in elderly patients and performing the necessary interventions, correcting glucose and potassium abnormalities during hospital admission may be effective in reducing mortality rates in patients with proximal femur fracture. Keywords: Emergency department, Proximal Femur Fracture, Glucose/Potassium ratio, Hemoglobin, RDW