Liver disease and mortality among patients with hip fracture: a population-based cohort study
Received 15 March 2018
Accepted for publication 28 May 2018
Published 21 August 2018 Volume 2018:10 Pages 991—1000
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Professor Irene Petersen
Jonathan Montomoli, Rune Erichsen, Henrik Gammelager, Alma B Pedersen
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
Purpose: The aim of this study was to examine the prognostic impact of liver disease on mortality following hip fracture (HF).
Patients and methods: This nationwide cohort study, based on prospectively collected data retrieved from Danish registries, included all patients diagnosed with incident HF in Denmark during 1996–2013. Patients were classified based on the coexisting liver disease at the time of HF, ie, no liver disease, noncirrhotic liver disease, and liver cirrhosis. We computed 30-day and 31–365-day mortality risks. To compare patients with and without liver disease, we computed mortality adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using Cox regression controlled for potential confounders.
Results: Among 152,180 HF patients, 2,552 (1.7%) patients had noncirrhotic liver disease and 1,866 (1.2%) patients had liver cirrhosis. Thirty-day mortality was 9.4% among patients with noncirrhotic liver disease, 12.6% among patients with liver cirrhosis patients, and 9.7% among patients without liver disease. Compared to patients without liver disease, crude and adjusted HRs within 30 days following HF were, respectively, 0.96 (95% CI: 0.85–1.10) and 1.24 (95% CI: 1.09–1.41) for patients with noncirrhotic liver disease and 1.30 (95% CI: 1.14–1.48) and 2.25 (95% CI: 1.96–2.59) for those with liver cirrhosis. Among patients who survived 30 days post-HF, the 31–365-day mortality was 18.5% among patients with noncirrhotic liver disease, 26.4% among patients with liver cirrhosis, and 19.4% among patients without liver disease. Corresponding crude and adjusted HRs were, respectively, 0.95 (95% CI: 0.86–1.04) and 1.08 (95% CI: 0.99–1.20) for patients with noncirrhotic liver disease and 1.40 (95% CI: 1.27–1.54) and 1.91 (95% CI: 1.72–2.12) for those with liver cirrhosis.
Conclusion: Liver disease patients, especially those with liver cirrhosis, had increased 30-day mortality and 31–365-day mortality following HF, compared to patients without liver disease.
Keywords: epidemiology, liver cirrhosis, hip fracture, mortality, noncirrhotic liver disease
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