Association Between High-Sensitivity Troponin T on Admission and Organ Dysfunction During Hospitalization in Patients Aged 80 Years and Older with Hip Fracture: A Single-Centered Prospective Cohort Study

Figures & data

Table 1 Diagnostic Criteria for MODSE^a

	Pre-Failure Stage	Failure Stage
Heart^b	i. Emerging arrhythmia, normal cardiac enzymes ii. Exertional dyspnea, no definite signs of heart failure iii. Increased PAWP (13 ~ 19mmHg)^c	i. Reduced stroke volume (EF ≤ 40%) ii. PAWP ≥ 20mmHg^d iii. Definite signs and symptoms of heart failure
Lung	i. PaCO2 45 ~ 49mmHg ii. SaO2 < 90% iii. pH 7.30 ~ 7.35 or 7.45 ~ 7.50 iv. 200mmHg < PaO2/FiO2 ≤ 300mmHg v. No MV requirement	i. PaCO2 > 50mmHg ii. SaO2 < 80% iii. pH < 7.30 iv. PaO2/FiO2 ≤ 200mmHg v. MV requirement
Kidney	i. Decreased UOP (20 ~ 40mL/h), good response to diuretics ii. Scr 177.0 ~ 265.2μmol/L (or > 20% increase from baseline) iii. No dialysis requirement	i. Decreased UOP (< 20mL/h) and poor response to diuretics ii. Scr > 265.2μmol/L (or > 20% increase from baseline) iii. Dialysis requirement
PC	i. Decreased UOP (20–40mL/h) ii. MAP 50 ~ 60mmHg or > 20% decrease from baseline, good response to vasopressors iii. Exclude hypovolemia	i. Decreased UOP (< 20mL/h) complicated with cold limbs and cyanosis ii. MAP < 50mmHg, multiple vasopressors and inotropic agents dependence iii. Exclude hypovolemia
Liver	i. TBIL 35 ~ 102μmol/L ii. ALT elevated < 2 × normal value iii. Markedly increased bilirubin with normal or decreased transaminases	i. TBIL ≥ 102μmol/L ii. ALT elevated > 2 × normal value iii. Hepatic encephalopathy
GT	i. Abdominal distension ii. Hypoactive bowel sounds iii. Acalculous cholecystitis	i. Severe abdominal distension, disappeared bowel sounds ii. Stress ulceration complicated bleeding or perforation iii. Necrotizing enteritis iv. Spontaneous gallbladder perforation
CNS	i. Obtundation ii. Disorientation iii. GCS 9 ~ 12	i. Diffuse neurologic injury ii. No response to speech or voice iii. No response to pain iv. GCS ≤ 8
CS	i. PLT 51 ~ 99 × 10^9/L ii. FIB ≥ 2 ~ 4g/L iii. PT and TT prolonged < 3s iv. D-dimer increased < 2 × normal value v. No obvious signs of bleeding	i. PLT ≤ 50 × 10^9/L with decreasing trend ii. FIB < 2g/L iii. PT and TT prolonged > 3s iv. D-dimer increased > 2 × normal value v. Obvious bleeding

Notes: ^aIf two or more organ functions meet the criteria for pre-failure stage while other organ functions are normal, a diagnosis of MODSE pre-failure stage is made. If two or more organ functions meet the criteria for failure stage while other organ functions are normal or in the pre-failure stage, a diagnosis of MODSE failure stage is made. Two or more abnormal values are required for the diagnosis of each criterion. ^bThe criterion of PAWP is replaced by LUS findings, ^creplaced by ≤ 30 B-lines on 28 zone LUS, ^dreplaced by > 30 B-lines on 28 zone LUS.

Abbreviations: PAWP, pulmonary artery wedge pressure; EF, ejection fraction; PaCO₂, partial pressure of carbon dioxide; SaO₂, arterial oxygen saturation; PaO₂, arterial partial pressure of oxygen; FiO₂, inspired oxygen concentration; MV, mechanical ventilation; UOP, urine output; Scr, serum creatinine; PC, peripheral circulation; MAP, mean arterial pressure; TBIL, total bilirubin; ALT, alanine aminotransferase; GT, gastrointestinal tract; CNS, central nervous system; GCS, Glasgow score; CS, coagulation system; PLT, platelet; FIB, fibrinogen; PT, prothrombin time; TT, thrombin time; LUS, lung ultrasound.

Table 2 Baseline Characteristics and Differences Between Low-Risk Group and High-Risk Group

		Total (n =168)	Group L (n = 77)	Group H (n = 91)	P
Age (years), mean (SD)		86.0 (4.4)	84.8 (4.0)	87.1 (4.5)	0.001
Gender (male), n (%)		46 (27.4)	11 (14.3)	35 (38.5)	< 0.001
Type of fracture (femoral neck), n (%)		70 (41.7)	28 (36.4)	42 (46.2)	0.213
Comorbidities, n (%)	Hypertension	78 (46.4)	33 (42.9)	45 (49.5)	0.439
	Diabetes	38 (22.6)	17 (22.1)	21 (23.1)	1.000
	Heart disease	30 (17.9)	11 (14.3)	19 (20.9)	0.315
	Lung disease	20 (11.9)	9 (11.7)	11 (12.1)	1.000
	CKD	7 (4.2)	0	7 (7.7)	0.016
	CNS disease	35 (20.8)	14 (18.2)	21 (23.1)	0.454
Stages of Heart Failure, n (%)	A	60 (35.7)	40 (51.9)	20 (22.0)	< 0.001
	B	97 (57.7)	37 (48.1)	60 (65.9)
	C	11 (6.5)	0	11 (12.1)
	D	0	0	0
mMRC, n (%)	0	1 (0.6)	1 (1.3)	0	0.828
	1	82 (48.8)	39 (50.6)	43 (47.3)
	2	76 (45.2)	33 (42.9)	43 (47.3)
	3	9 (5.4)	4 (5.2)	5 (5.5)
	4	0	0	0
WST (abnormal), n (%)		17 (10.1)	3 (3.9)	14 (15.4)	0.014
MMSE, median (range)		26.0 (24.0–28.0)	26.0 (25.5–28.0)	26.0 (22.8–28.0)	0.004
Barthel index, median (range)		35.0 (28.5–45.0)	35.0 (30.0–45.0)	35.0 (20.0–45.0)	0.158
RDW (%), mean (SD)		13.9 (1.7)	13.8 (1.5)	14.0 (1.9)	0.483
Vital signs, mean (SD)	SBP (mmHg)	134.4 (19.9)	134.7 (20.6)	134.1 (19.5)	0.857
	DBP (mmHg)	73.2 (10.9)	72.0 (10.6)	74.3 (11.1)	0.169
	HR (beats/min)	84.5 (15.1)	83.5 (15.2)	85.3 (15.1)	0.437
	RR (breaths/min)	19.9 (0.8)	19.9 (0.6)	20.0 (0.9)	0.787

Abbreviations: SD, standard deviation; CKD, chronic kidney disease; CNS, central nervous system; mMRC, modified British Medical Research Council dyspnoea scale; WST, Water Swallow Test; MMSE, Mini-Mental State Examination; RDW, red cell distribution width; SBP, systemic blood pressure; DBP, diastolic blood pressure; HR, heart rate; RR, respiratory rate.

Table 3 Perioperative Information and Differences Between Low-Risk Group and High-Risk Group

	Total (n = 168)	Group L (n = 77)	Group H (n = 91)	P
Basic information on operation day
Time-to-surgery (days), median (range)	6.0 (4.0–9.0)	5.0 (4.0–8.0)	6.0 (5.0–9.0)	0.029
Operation time (min), median (range)	50.0 (40.0–60.0)	50.0 (40.0–67.5)	50.0 (40.0–60.0)	0.165
Total venous input (mL), mean (SD)	3126.0 (569.3)	3117.1 (609.8)	3133.5 (535.9)	0.853
Average hourly UOP (mL), median (range)	57.5 (42.0–80.0)	57.5 (42.2–77.9)	57.2 (41.0–82.0)	0.880
APACHEII score, median (range)	10.0 (8.0–12.0)	9.0 (8.0–12.0)	10.0 (8.0–12.0)	0.315
Blood transfusion, n (%)	75 (44.6)	37 (48.1)	38 (41.8)	0.439
Human albumins infusion, n (%)	65 (38.7)	25 (32.5)	40 (44.0)	0.153
Diuretic use, n (%)	31 (18.5)	11 (14.3)	20 (22.0)	0.234
Laboratory findings on the first day after surgery
WBC (×10^9/L), mean (SD)	8.6 (2.8)	8.4 (3.1)	8.7 (2.5)	0.393
NEUT (×10^9/L), mean (SD)	6.7 (2.5)	6.5 (2.9)	6.9 (2.2)	0.269
LYMPH (×10^9/L), median (range)	0.8 (0.6–1.2)	0.9 (0.7–1.3)	0.8 (0.6–1.0)	0.003
NLR, median (range)	7.6 (5.1–10.2)	6.1 (4.4–8.6)	8.9 (6.2 −11.3)	< 0.001
RBC (×10^9/L), mean (SD)	3.4 (0.6)	3.3 (0.5)	3.4 (0.5)	0.218
RDW (%), mean (SD)	14.3 (2.1)	14.3 (1.8)	14.4 (2.2)	0.715
HGB (g/L), mean (SD)	101.2 (12.7)	99.4 (12.1)	102.8 (13.6)	0.081
PLT (×10^9/L), mean (SD)	166.9 (63.3)	164.4 (61.8)	169.0 (64.7)	0.641
PT (s), median (range)	14.4 (13.9–15.1)	14.2 (13.6–15.0)	14.4 (14.1–15.2)	0.024
APTT (s), mean (SD)	41.5 (6.4)	41.0 (6.4)	41.9 (6.5)	0.388
INR, median (range)	1.2 (1.2–1.3)	1.2 (1.1–1.3)	1.2 (1.2–1.3)	0.024
TT (s), median (range)	16.1 (15.1–17.8)	15.9 (15.1–17.8)	16.4 (15.6–17.9)	0.315
FIB (g/L), mean (SD)	4.1 (0.9)	4.0 (0.9)	4.1 (0.9)	0.254
D-D (μg/mL), median (range)	2.7 (1.7–5.6)	2.8 (1.7–6.4)	2.7 (1.8–5.4)	0.707
FDP (μg/mL), median (range)	9.7 (5.3–20.6)	10.3 (5.1–23.4)	9.6 (5.4–20.2)	0.658
pro-BNP (pg/mL), median (range)	700.0 (352.8–1315.8)	475.1 (304.7–897.3)	989.3 (539.4–1734.0)	< 0.001
hs-TnT (pg/mL), median (range)	17.0 (11.0–28.0)	10.0 (10.0–15.0)	26.0 (17.0–39.0)	< 0.001
PCT (ng/mL), median (range)	0.2 (0.1–0.2)	0.1 (0.1–0.2)	0.2 (0.1–0.2)	0.027
IL-6 (pg/mL), median (range)	151.1 (95.2–223.2)	141.6 (87.5–199.5)	161.6 (111.8–233.7)	0.022
ALT (U/L), median (range)	17.0 (11.0–25.0)	17.0 (11.0–28.0)	17.0 (12.0–24.0)	0.966
TBIL (μmol/L), median (range)	12.1 (8.8–17.4)	12.0 (8.8–17.2)	12.6 (8.8–18.1)	0.825
PA (mg/L), mean (SD)	117.3 (35.6)	118.7 (35.4)	110.2 (34.9)	0.540
ALB (g/L), mean (SD)	29.6 (3.3)	29.8 (3.1)	30.1 (3.5)	0.332
Scr (μmol/L), median (range)	61.0 (48.0–81.8)	55.0 (47.0–73.5)	69.0 (52.0–90.0)	0.001
CysC (mg/L), median (range)	1.2 (1.0–1.6)	1.1 (1.0–1.4)	1.3 (1.1–1.8)	< 0.001
UA (μmol/L), median (range)	220.0 (168.3–296.3)	202.0 (159.5–255.5)	247.0 (183.0 −312.0)	0.008
Glucose (mmol/L), median (range)	5.9 (5.2–6.9)	5.8 (5.2–6.8)	6.0 (5.2–6.9)	0.596
Potassium (mmol/L), mean (SD)	4.1 (0.4)	4.1 (0.4)	4.2 (0.4)	0.160
Sodium (mmol/L), median (range)	138.5 (137.0–140.8)	139.0 (137.5 −140.0)	138.0 (136.0 −141.0)	0.460
Chloride (mmol/L), mean (SD)	102.3 (3.8)	102.3 (3.1)	102.3 (4.3)	0.982
Calcium (mmol/L), mean (SD)	2.0 (0.1)	2.0 (0.1)	2.0 (0.1)	0.325
Phosphorus (mmol/L), mean (SD)	1.1 (0.2)	1.1 (0.2)	1.1 (0.2)	0.983
Arterial pH, mean (SD)	7.39 (0.04)	7.39 (0.04)	7.39 (0.04)	0.919
PaO2/FiO2 (mmHg), median (range)	283.0 (242.1–333.0)	278.0 (242.0–313.6)	290.0 (245.0–354.6)	0.322
PaCO2 (mmHg), mean (SD)	42.0 (6.6)	43.1 (5.7)	41.4 (7.1)	0.053
SB (mmol/L), mean (SD)	24.8 (3.0)	25.7 (1.9)	24.7 (2.7)	0.007
Lactate (mmol/L), median (range)	1.0 (0.9–1.3)	1.0 (0.9–1.2)	1.1 (0.9–1.3)	0.234

Abbreviations: SD, standard deviation; UOP, urine output; APACHE, acute physiology and chronic health evaluation; WBC, white blood cell count; NEUT, neutrophil count; LYMPH, lymphocyte count; NLR, neutrophil-to-lymphocyte ratio; RBC, red blood cell count; RDW, red cell distribution width; HGB, haemoglobin; PLT, platelet count; PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio; TT, thrombin time; FIB, fibrinogen; D-D, D-dimer; FDP, fibrin (ogen) degradation products; pro-BNP, pro-brain natriuretic peptide; hs-TnT, high-sensitivity cardiac troponin T; PCT, procalcitonin; IL-6, interleukin-6; ALT, alanine aminotransferase; TBIL, total bilirubin; PA, prealbumin; ALB, albumin; Scr, serum creatinine; CysC, cystatin C; UA, uric acid; GLU, glucose; PaO₂, arterial partial pressure of oxygen; FiO₂, inspired oxygen concentration; PaCO₂, partial pressure of carbon dioxide; SB, standard bicarbonate.

Figure 1 Incidence of MODSE and single organ dysfunction in 168 patients. Figure shows the overall incidence of organ dysfunction and its distribution between the two groups.

Abbreviations: MODSE, multiple organ dysfunction syndrome in the elderly; CNS, central nervous system; PC, peripheral circulation; GT gastrointestinal tract; CS coagulation system.

Table 4 Admission High-Sensitivity Troponin T and Perioperative Outcomes

Outcome	Admission hs-TnT			Univariable OR (95% CI)	P	Multivariable OR (95% CI)	P
	Outcome Present	Outcome Absent	P
MODSE (n=39)	22.0 (15.0–34.0)	14.0 (10.0–22.0)	< 0.001	3.72 (1.64–8.45)	0.002	5.76 (1.74–19.10)	0.004
Single organ dysfunction
Lung (n = 81)	15.0 (11.0–22.0)	17.0 (10.0–27.0)	0.652	0.92 (0.50 −1.69)	0.786	–	–
CNS (n = 35)	21.0 (11.0–30.0)	15.0 (10.0–22.5)	< 0.001	2.15 (0.98–4.74)	0.058	–	–
Heart (n = 33)	22.0 (14.5–43.5)	14.0 (10.0–22.0)	0.002	3.27 (1.38–7.58)	0.007	7.48 (2.17–25.82)	0.001
PC (n = 29)	13.0 (10.0–22.0)	17.0 (11.0–25.0)	0.426	0.54 (0.24–1.21)	0.132	–	–
Kidney (n = 23)	26.0 (13.0–41.0)	15.0 (10.0–22.0)	0.001	2.13 (0.83–5.49)	0.116	–	–
GT (n = 11)	21.0 (15.0–71.0)	15.0 (10.0–24.0)	0.057	4.12 (0.86–19.66)	0.076	–	–
CS (n = 11)	24.0 (10.0–32.0)	16.0 (11.0–23.0)	0.179	2.38 (0.61–9.30)	0.213	–	––
Liver (n = 6)	15.0 (10.0–24.0)	24.0 (21.0–31.0)	0.024	4.42 (0.51–38.66)	0.179	–	–
MODS severity score > 3 (n = 28)	23.0 (15.8–36.3)	14.0 (10.0–22.0)	0.009	4.87 (1.75–13.54)	0.002	5.22 (1.32–20.60)	0.018
LOS > 14 (n = 88)	18.0 (11.0–30.0)	13.5 (10.0–20.0)	0.010	2.04 (1.10–3.77)	0.024	2.38 (1.05–5.36)	0.037

Note: Adjustments: age, sex, type of fracture, time-to-surgery, hypertension, diabetes, chronic CNS disease, chronic kidney disease, modified British Medical Research Council dyspnoea scale, Water Swallow Test, Mini-Mental State Examination, Barthel index, RDW, vital signs.

Abbreviations: OR, odds ratio; CI, confidence interval; MODSE, multiple organ dysfunction syndrome in the elderly; CNS, central nervous system; PC, peripheral circulation; GT, gastrointestinal tract; CS, coagulation system; LOS, length of hospital stay.