Lower estimated glomerular filtration rate at admission is associated with a worse outcome in older patients with hip fracture who undergo surgical treatment

  1. da Casa, Carmen 1
  2. Vidal-Terrancle, Marta 2
  3. Hierro-Estévez, María Agustina 1
  4. Montoya-Saenz, Rocío
  5. Fidalgo, Helena 1
  6. González-Ramírez, Alfonso 1
  7. Pablos-Hernández, Carmen 2
  8. Blanco, Juan F
  1. 1 Instituto de Investigación Biomédica de Salamanca (IBSAL). Salamanca. España.
  2. 2 Servicio de Cirugía Ortopédica y Traumatología. Hospital Universitario de Salamanca. Salamanca. España.
Revue:
Anales del sistema sanitario de Navarra

ISSN: 1137-6627

Année de publication: 2023

Volumen: 46

Número: 1

Pages: 31-40

Type: Article

DOI: 10.23938/ASSN.1036 DIALNET GOOGLE SCHOLAR lock_openAccès ouvert editor

D'autres publications dans: Anales del sistema sanitario de Navarra

Objectifs de Développement Durable

Résumé

Fundamento. Evaluar la influencia de los valores de filtrado glomerular estimado (eFG) al ingreso en el pronóstico de los pacientes mayores con fractura de cadera tratados quirúrgicamente. Métodos. Estudio prospectivo de pacientes >65 años, tratados quirúrgicamente por una fractura de cadera primaria, sin etiología tumoral o traumatismo de alta energía, en un hospital universitario terciario entre 2018 y 2019. Estratificamos a los pacientes según el FG al ingreso y estudiamos su asociación con distintas variables demográficas y clínicas, incluida la mortalidad hasta 90 días después del alta hospitalaria. Resultados. Se incluyeron 942 pacientes. La disminución del eFG se asoció significativamente a peor estado funcional, mayor incidencia de complicaciones médicas postoperatorias, mayor disfunción renal postoperatoria y mayor necesidad de transfusión sanguínea. La mortalidad mostró un patrón en escalera que aumentaba con la disminución del eFG. A los 90 días, la mortalidad fue significativamente mayor en pacientes con eFG <60. Los pacientes con enfermedad renal crónica que sufrían una fractura de cadera y experimentan al ingreso una variación significativa del eFG (>5 mL/min/1,73m2) respecto a los valores basales mostraron una tasa de mortalidad intrahospitalaria del 10,7%. Conclusiones. Los pacientes ancianos tratados quirúrgicamente por fractura de cadera con valores más bajos de tasa de eFG presentan peor estado funcional y peor pronóstico. Una variación clínica significativa del FG (>5) en el momento del ingreso hospitalario tras una fractura de cadera podría asociarse a un aumento de la mortalidad intrahospitalaria de los pacientes con insuficiencia renal crónica.

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