Journal of Bacteriology & Parasitology

High Mortality of COVID-19 Infection in Hip Fractures

Ahmed Fadulelmola^* Department of Trauma and Orthopaedics, University Hospital of North Durham, Durham, United Kingdom
^*Correspondence: Dr. Ahmed Fadulelmola, Department of Trauma and Orthopaedics, University Hospital of North Durham, Durham, United Kingdom, Email:

Received: 30-Nov-2020 Published: 22-Dec-2020, DOI: 10.35248/2155-9597.20.S5.004

Description

• There was a significant difference of mortality rate in COVID-19 positive group (n=10, 50%) compared to COVID-19 negative group (n=4, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0-22.5 days, p=0.003) [1,2].

• 30% (n=6) contracted the COVID-19 infection in the community and 70% (n=14) developed symptoms after hospital admission.

• The average White Cell Count (WCC) in COVID-19 positive patients was 12.3 × 10⁹ cells/litre compared to 11.2 × 10⁹ cells/ litre in COVID-19 negative patients, p=0.02. There was a statistical difference in the average Lymphocytes count between the two groups, with 0.7 × 10⁹ cells/litre in Covid-19 positive group, and 1.1 × 10⁹ cells/litre in Covid-19 negative group, p=0.01. The mean C reactive protein was 46.7 compared to 33.7, p=0.3, in Covid-19 positive and negative cases, respectively.

• 100% (n=20) had shown symptoms of fever and cough. All ten (100%) deceased cases had hypoxia. Seven (35%) cases had radiology lung findings of new pulmonary infiltrates, consistent of viral pneumonitis which resulted in mortality (70% of mortality, p=0.01). All ten (50%) survivals had no features of viral pneumonitis. All of the twenty positive patients had received oxygen supplement and seven (35%) had received antibacterial therapy.

Discussion

The Covid-19 virus causes a two-phase immune response [3]. The second phase, cytokine release syndrome (CRS) causes immune mediated lung damage and/or multi-organ failure, and leads to death. CRS is characterized by leucocytosis associated with lymphopenia. We found in our study that COVID-19 positive patients had significantly higher mean Leukocytes counts and lower mean lymphocytes count compared to COVID-19 negative patients. We have postulated that in hip fractures associated with Covid-19 infection there are three potential hits, trauma, COVID-19 infection and surgery. Hip fracture surgery may act as a ‘‘third hit’’ that boost the hyper immune state caused by COVID-19 virus and this may be a major factor in the increased mortality. Dexamethasone was shown to reduce COVID-19 mortality by suppressing the immune response which supports our theory [4].

Interestingly, we have observed radiological evidence of viral pneumonitis in 35% of patients of COVID-19, which all resulted in death. On the other hand, all Covid-19 positive survivals (10 patients) had normal Chest X rays. This suggests that Chest X ray findings of viral pneumonitis can be an indicator of mortality.

Conclusion

Despite relative small sample size, our research gives a platform to explore further outcomes and pathophysiology effects of this intriguing virus. Immunological researches looking to different cytokines profiles can lead to an important discovery of a treatment of this virus. Furthermore, it opens the door for further researches looking to the radiological predictors of mortality in COVID-19 infection. Meanwhile, this study gives an insight of the significant effect of this virus infection on the mortality of surgical patients which helps in counseling patients and relatives.

REFERENCES

1. Fadulelmola A, Gregory R, Gordon G, Smith F, Jennings A. The impact of Covid-19 infection on hip fractures 30-day mortality. Trauma. 2020;1(1):2-6.
2. National Hip Fracture Database (NHFD) Annual Report 2019. Royal College of Physicians. 2020.
3. Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: The perspectives on immune responses. Cell Death Differ. 2020;27(5):1451-1454.
4. Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19. University of Oxford. 2020.