Biomarkers for Prediction of Cardiovascular Complications in Hip Fracture Surgery in the Elderly

To evaluate and synthesize evidence on the prognostic value of circulating biomarkers -B-type natriuretic peptide (BNP)/N-terminal pro-BNP (NT-proBNP), troponins T and I, C-reactive protein (CRP), and soluble urokinase plasminogen activator receptor (suPAR) -for short-and long-term mortality in elderly patients undergoing hip fracture surgery, we hypothesized that elevated biomarker levels reflect frailty and underlying cardiac and non-cardiac pathology and predict mortality.We conducted a narrative review of clinical studies in geriatric hip fracture cohorts reporting preoperative and/or postoperative measurements of these biomarkers, extracting study design, timing of sampling, biomarker thresholds, associations with all-cause and cardiovascular mortality, and whether analyses adjusted for age, comorbidity, and surgical factors.Multiple studies report postoperative troponin elevations linked to worse long-term prognosis and higher mortality.BNP and NT-proBNP consistently correlate with cardiovascular risk and increased mortality when measured preoperatively or early postoperatively, with several studies describing nonlinear relationships and threshold effects.CRP shows variable association with mortality, often reflecting infection or systemic inflammatory burden, and composite ratios (e.g., CRP-to-albumin ratio, CRP-to-lymphocyte ratio) may improve prognostic performance.suPAR is associated with multimorbidity and premature death in general populations; data specific to hip fracture patients are limited but suggest higher suPAR quartiles relate to increased 30-day mortality.Heterogeneity in timing of sampling, biomarker thresholds, and statistical adjustments across studies limits definitive recommendations.Overall, BNP/NT-proBNP, troponins, CRP, and suPAR show promise for risk stratification in hip fracture patients, but prospective standardized studies are needed to define optimal markers, timing, and clinical utility.