The Open Orthopaedics Journal

ISSN: 1874-3250 ― Volume 14, 2020

Prognostic Significance Of Serum Urea Concentration at Admission in older patients with hip fracture

Alexander Fisher1, 2, 4, *, Leon Fisher3, Wichat Srikusalanukul1, Paul N Smith2, 4
1 Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra, Australia
2 Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra, Australia
3 Frankston Hospital, Peninsula Health, Melbourne, Australia
4 Australian National University Medical School, Canberra, ACT, Australia



There are unmet needs in objective prognostic indicators for Hip Fracture (HF) outcomes.


To evaluate the determinants and prognostic impact of elevated serum urea, a key factor of nitrogen homeostasis, in predicting hospital mortality, inflammatory complications and length of stay in HF patients.


In 1819 patients (mean age 82.8±8.1 years; 76.4% women) with osteoporotic HF, serum urea level at admission along with 22 clinical and 35 laboratory variables were analysed and outcomes recorded. The results were validated in a cohort of 455 HF patients (age 82.1±8.0 years, 72.1% women).


Elevated serum urea levels (>7.5mmol/L) at admission were prevalent (44%), independently determined by chronic kidney disease, history of myocardial infarction, anaemia, hyperparathyroidism, advanced age and male gender, and significantly associated with higher mortality (9.4% vs. 3.3%, p<0.001), developing a high postoperative inflammatory response (HPIR, 22.1% vs.12.1%, p=0.009) and prolonged hospital stay (>20 days: 31.2% vs. 26.2%, p=0.021). The predictive value of urea was superior to other risk factors, most of which lost their discriminative ability when urea levels were normal. Patients with two abnormal parameters at admission, compared to subjects with the normal ones, had 3.6-5.6 -fold higher risk for hospital mortality, 2.7-7.8-fold increase in risk for HPIR and 1.3-1.7-fold higher risk for prolonged hospital stay. Patients with increased admission urea and a high inflammatory response had 9.7 times greater mortality odds compared to patients without such characteristics.


In hip fracture patients admission serum urea is an independent and valuable predictor of hospital outcomes, in particular, mortality.

Keywords: Serum urea, Hip fracture, Hospital outcomes, Prognosis, Prediction, Mortality.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 536
Last Page: 553
Publisher Id: TOORTHJ-12-536
DOI: 10.2174/1874325001812010536

Article History:

Received Date: 26/07/2018
Revision Received Date: 31/10/2018
Acceptance Date: 09/11/2018
Electronic publication date: 30/11/2018
Collection year: 2018

© 2018 Fisher et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Geriatric Medicine, The Canberra Hospital and ANU Medical School, PO Box 11, Woden, ACT 2606, Australia: Tel: +61-2-51243738, Fax: +61-2-51244036, Email:

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