MO533WHICH PARAMETERS BEST PREDICT POSITIVE COVID-19 STATUS FOLLOWING HIP FRACTURE FOR PATIENTS LIVING WITH CKD?
Authors: Wu Henry , Van Mierlo Reinier , Challen Kirsty , McLauchlan George , Dhaygude Ajay , Mitra Sandip , Nixon Andrew 
Published: May 2021

Abstract

Background and Aims
Patients living with chronic kidney disease (CKD) are at greater susceptibility of sustaining hip fractures compared to those without CKD due to higher falls risk. Post-trauma clinical outcomes for patients living with CKD are exacerbated by frailty, co-morbidities and sarcopenia. Patients living with CKD may require lengthy hospitalization following hip fracture, considering the additional indications for extensive treatment and rehabilitation. A long hospital stay may bring greater risks of contracting COVID-19, given the magnitude of this current global pandemic. Complications from COVID-19 significantly increase mortality risks for older patients living with CKD after acute trauma, as a considerable proportion will have a poor baseline health and functional status. Our study aims to determine the most useful clinical and laboratory assessment tools to predict for a positive COVID-19 status following hospitalization with hip fracture in patients living with CKD.

Method
Patients with CKDG3b-5 admitted from home to a tertiary hospital in North West UK with hip fracture between Feb and Dec 2020 were included. Each patient included in this study received at least one COVID-19 nasopharyngeal swab during their hospitalization. Parameters assessed on hospital admission for each patient included Clinical Frailty Scale (CFS), Charlson’s Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Estimated VO2 Peak, Karnofsky Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, ASA Physical Status Classification System Score and Abbreviated Mental Test Score. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual parameters to predict for a positive COVID-19 status following hip fracture in patients living with CKD. Events of 30-day mortality were recorded.

Results
92 patients met study inclusion criteria. The mean age was 84.6±7.8 years and the female:male ratio was 1.6:1. 7 patients (7.6%) were on long-term dialysis and the mean eGFR amongst non-dialysis patients was 36.5±13.8 ml/min/1.73m2. The median length of hospitalization was 17 days. 22 patients (23.9%) tested positive for COVID-19. Area under a Curve (AUC) values from ROC analyses are shown in Table 1. The difference in 30-day mortality rate between patients who tested positive for COVID-19 and those who tested negative was +6.8% (p&lt;0.001).

Conclusion
Frailty and co-morbidity assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for positive COVID-19 status following hip fracture in patients living with CKD. A continuous, holistic multi-disciplinary team approach during hospitalization for comprehensive geriatric assessment and optimization of medical co-morbidities may improve outcomes, in anticipation of a potential lengthy hospital stay. To improve prognosis, research efforts should continue to explore avenues on reducing COVID-19 rates within this patient population.