Euthyroid Sick Syndrome (ESS) in proximal femoral fractures: a proof-of-concept evaluation of postoperative outcomes in elderly patients

OBJECTIVE: The diagnosis of euthyroid sick syndrome (ESS) in several diseases has been associated with poor outcomes, and proximal femur fractures are among the most common injuries in elderly patients, representing a leading cause of disability and mortality. There are no studies evaluating the mortality rate in patients with proximal femur fractures and ESS. The aim of our study was to evaluate a potential higher mortality rate in geriatric patients with proximal femur fracture and affected by ESS. MATERIALS AND METHODS: In this proof-of-concept study, all patients older than 65 years with a diagnosis of proximal femur fracture were included. They were all treated surgically. The main exclusion criteria were acute cardio-pulmonary events, neoplastic diseases, and any thyroid or endocrine pathology. RESULTS: Thirty-six patients who met our criteria were enrolled: 20 of them had a diagnosis of ESS (Group A), while 16 had a normal thyroid function as control (Group B). The mortality rate was evaluated at one month, three months, six, and twelve months after surgery. The survival analysis of enrolled patients showed a higher mortality rate in patients with ESS (p = 0.049) regardless of baseline comorbidities. CONCLUSIONS: The ESS could be included among the predictive factors of all-cause mortality in geriatric patients with proximal femur fracture.