Hip fracture mortality in patients co-infected with coronavirus disease 2019: a comparison of the first two waves of the United Kingdom pandemic during the pre-vaccine era

Abstract

Aims In the UK, deaths associated with COVID-19 have occurred in two waves. Evidence has shown an increase in 30-day mortality for hip fracture patients co-infected with COVID-19. However, there are no studies analysing mortality trends between the first two waves of the UK pandemic. Additionally, hospital versus community acquired COVID-19 infection between the two waves has not been analysed. Furthermore, predictive factors of 30-day mortality have not been fully evaluated. Methods Data from two audits conducted by the CHIP collaborative group were used: a published regional audit in England of nine hospitals providing the COVID-19 negative cases and an unpublished UK national audit of 43 hospitals, which provided the COVID-19 positive cases. Data collection for the COVID-19 positive cases was from 23 March to 31 December 2020. September 1, 2020 was used to define the transition between the two waves. Results There were 517 COVID-19 positive hip fracture patients and 1445 COVID-19 negative hip fracture patients. Overall, 30-day mortality rates were 5.7% in the COVID-19 negative group and 22.4% in the COVID-19 positive patients ( p < 0.001). A difference in survival function between the first and second waves was found ( p = 0.038). To allow for significant demographic differences, a matched analysis of 185 patients found a 26.5% 30-day mortality in the first wave compared to 21.1% in the second wave ( p = 0.222). Within the COVID-19 positive groups, the virus was hospital acquired in 66.7% of cases in the first wave and 72.8% of cases in the second wave ( p = 0.130). Independent predictors of mortality were found to include COVID-19 positive status, AMTS ≤ 6, male gender and age. Conclusion There was a reduction in 30-day mortality for hip fracture patients co-infected with COVID-19 between the two UK pandemic waves but this was not statistically significant. There was no reduction in hospital acquired COVID-19 infection between the two waves.

Coronavirus in hip fractures (CHIP) 4

“…Significant differences in baseline demographics did exist between the early patient cohorts, but these have been described in detail elsewhere. 19…”

“…For the unvaccinated patients the mortality remained high at 21.7%, similar to mortality rates reported in our CHIP 3 study (26.1% in the first wave and 19.4% in the second wave). 19 This highlights the need to promote vaccination of this patient group.…”

“…We defined infection as being hospital-acquired if the patient had an initial negative PCR test on admission but subsequently tested positive in the perioperative period, the same definition used in our previous CHIP studies. 14,19 Nottingham Hip Fracture Score (NHFS) was calculated for all patients. 29…”

“…COVID-19 has been shown to be an independent risk factor for mortality with the Coronavirus in Hip fractures (CHIP) 3 study revealing COVID-19 infection was the biggest independent predictor of mortality, ahead of Abbreviated Mental Test Score (AMTS), 18 male sex, and age. 19 Similarly, Hall et al 20 found a three-times increased 30-day mortality risk, independent of confounding variables. Our CHIP 3 study found that mortality across the first two waves of the UK pandemic had reduced from 26.1% to 19.4%; however, this was not significant when accounting for frailty by using matched controls.…”

Angiotensin converting enzyme 2 (ACE2): Virus accomplice or host defender

“…As we all know, the expression of ACE2 in male is higher than that in female and high ACE2 expression will make them more susceptible to infection. 47,48 However, in the reports we collected, [49][50][51][52][53][54][55][56][57][58] the positive rate of females was higher than that of males, and the proportion of males among asymptomatic infections was higher (Fig. 6a and b).…”