The Prognostic Implication of Preoperative Troponin Elevation at Hospital Admission in Hip Fracture Patients: A Systematic Review and Meta-Analysis

BACKGROUND: The purpose of our study was to evaluate the prognostic significance of preoperative troponin elevation in patients who have hip fractures. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) or observational studies published up to December 2025 comparing patients who have elevated cardiac troponin levels at hospital admission with those presenting normal troponin levels in patients who have hip fractures. Risk ratios (RR) were used to evaluate binary outcomes and mean differences (MD) for continuous endpoints, with 95% confidence intervals (CI). RESULTS: A total of five studies comprising 2,148 patients who had hip fractures were included. The group with normal troponin at admission had significantly lower overall mortality compared to the group with elevated troponin (RR 2.11; 95% CI 1.63 to 2.74; P < 0.01). In a subgroup analysis, mortality at one month (RR 3.65; 95% CI 1.59 to 8.39; P < 0.01) and three months (RR 1.98; 95% CI 1.51 to 2.60; P < 0.01) was also significantly lower in patients with normal troponin at hospital admission. However, there were no significant differences between groups for arrhythmia, congestive heart failure, or lengths of hospital stay. CONCLUSIONS: Preoperative elevation of cardiac troponin at hospital admission was consistently associated with an increased risk of mortality, supported by low to moderate-certainty evidence. These findings support the potential role of admission troponin as an accessible prognostic biomarker for early risk stratification in this high-risk population.