NT ‐ proBNP With Postoperative Complications and 2‐Year Mortality Among Hip Fracture Patients: An Observational Cohort Study

OBJECTIVE: Hip fracture causes significant morbidity and mortality, necessitating the identification of biomarkers for risk stratification. This study aimed to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and incidence of postoperative complications and the 2-year all-cause mortality among hip fracture patients. METHODS: This retrospective cohort study involved 2595 patients aged from 45 years who received surgery for hip fracture between 2000 and 2022. Preoperative NT-proBNP levels were used to divide patients into three groups: low (< 123.27 pg/mL), moderate (123.27-349.93 pg/mL), and high (> 349.93 pg/mL) NT-proBNP group. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the odds ratio (OR) for postoperative complications and the hazard ratio (HR) for mortality, after adjusting for potential confounders. RESULTS: Post-operative complications were reported in 171 (6.59%) patients with mortality of 226 (8.71%) during the 2-year follow-up. Compared to patients with low NT-proBNP group, the adjusted odds ratio for postoperative complications was 1.21 (95% CI 0.69-2.15) for those in the moderate NT-proBNP group and 2.33 (95% CI 1.35-4.03) for those in the high NT-proBNP group. Similarly, the adjusted hazard ratio for 2-year all-cause mortality was 1.51 (95% CI 0.91-2.50) for those in the moderate NT-proBNP group and 2.66 (95% CI 1.63-4.32) for those in the high NT-proBNP group. Higher pre-operative NT-proBNP levels were associated with an increased risk for postoperative complications and 2-year all-cause mortality (both p for trend < 0.001) among hip fracture patients. The results were consistent across various subgroup and sensitivity analyses. CONCLUSION: Preoperative NT-proBNP is strongly associated with both postoperative complications and 2-year all-cause mortality among patients received hip fracture surgery. Higher levels of NT-proBNP before surgery may serve as a useful biomarker for risk stratification and guiding treatment decisions for this patient subpopulation.