Risk factors for mortality after surgery of osteoporotic hip fracture in patients over 65 years of age. / Factores de riesgo de mortalidad tras intervención quirúrgica de fractura de cadera osteoporótica en pacientes mayores.

OBJECTIVE: To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. MATERIAL AND METHODS: A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. RESULTS: The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. DISCUSSION AND CONCLUSION: Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan.

[Still's disease: atypical manifestations and potential markers of severe visceral disease]. / Enfermedad de Still: manifestaciones atípicas y posibles marcadores de afectación visceral severa.

We present two patients with Still's disease which, in addition to the typical clinical manifestations, showed rare visceral alterations. The first case referred abdominal pain and a sustained hyperamilasemia was detected. The second case suffered a severe multiple organic failure, characterized by hepatic failure, with electric signs of encephalopathy, hydroelectrolytic disorder, rhabdomyolysis and disseminated intravascular coagulation. During this episode, we detected hyponatremia, reduction of leukocytes and normalization of GSR, modifications already described by other authors in cases similar to these ones, although without considered relevant until now. We comment these results and their value as markers of visceral affectation.