Background A prospective cohort study of consecutively hospitalized elderly patients with acute hip fracture was performed to examine the impact of inflammatory response on the early alerting for short-term mortality in elderly hip fractures with chronic obstructive pulmonary disease(COPD).Methods Between August 2006 and August 2009,345 patients were admitted,and 73 patients were diagnosed as having COPD.Epidemiological characteristics,chronic medical conditions,types of operation,and length of stay were recorded.Follow-up included mortality at 30-day,6-month,and 1-year after operation and functional recovery at 1 year after operation.Blood samples for cytokine analysis were drawn at admission,pre-operatively(post-anaesthesia),and at 1h,1 day,3 days and 5 days postoperatively.Results The hip fracture with COPD had shown a significantly higher level of TNF-a,IL-6 and IL-10 at all time point compared to hip fracture without COPD.In patients with COPD the mortality was significantly higher than patients without COPD.There was significant difference between functional outcome of patients with COPD and without COPD after one 2 year,which patients with COPD presented significantly lower(p=0.000)ADL scores than patients without COPD.In addition,only 13/36 patients ADL scores in patients with COPD returned to their pre-injury states,on the contrary 98/208 persons ADL in patients without COPD returned to their previous status.Conclusions Persons with COPD had much higher risk of death following hip fracture than those without COPD,and the inflammatory response played an important role in the early alerting for short-term mortality in elderly hip fracture with COPD.