Abstract

Background: The acute phase response (APR) is systemic body reaction to tissue injury, and its dysregulation leads to poor outcomes. Acute phase reactants exhibit a lot of variation, which makes differential diagnosis difficult – especially in fragile patients. The aim of the present study is to describe the perioperative acute phase response kinematics in hip fracture patients.

Materials and methods: 431 hip fracture patients over 65 years old who underwent surgical treatment were included in a prospective study. Pre-operative C reactive protein, albumin, vitamin D, and fibrinogen concentrations and C reactive protein of the 3–4th day post-operatively were obtained. Patients were followed up for 30 days and all infectious complications were removed.

Results: The admission C-reactive protein (CRP) levels exhibited a statistically significant negative correlation with both albumin (p = .038) and vitamin D (p = .021). On the first post-operative day, patients with femoral neck fractures showed statistically significantly lower CRP levels compared to those with intertrochanteric (p = .046) and subtrochanteric (p = .007). This pattern persisted on the 3rd–4th postoperative days (p < .001). Hemiarthroplasty, total hip arthroplasty, and cannulated screws groups demonstrated statistically lower post-operative CRP values compared to the dynamic hip screw (p < .001, p < .001, p = .024) and proximal femoral nail groups (p < .001, p < .001, p = .024).

Conclusions: Surgeries for extracapsular hip fractures are associated with a greater acute phase response compared to surgeries for intracapsular fractures. Vitamin D was found as possible negative acute phase reactant.