Adunsky A, Arad M, Blumstein T, Weitzman A, Mizrahi E H
Department of Geriatric Rehabilitation and the Orthogeriatric Unit, Sheba Medical Center, Tel-Hashomer, Israel.
Eur J Phys Rehabil Med. 2008 Dec;44(4):417-22.
Low hemoglobin level is considered a marker of poor functional outcome. The objective of this study was to explore possible relationship of discharge hemoglobin levels and functional outcome of elderly hip fracture patients, undergoing in-hospital rehabilitation.
A retrospective chart review study, comprising consecutive elderly patients suffering traumatic hip fractures. Main outcome measurement was the functional outcome of patients, as assessed by motor and total Functional Independence Measurement (FIM) scores upon admission and discharge.
Mean discharge hemoglobin levels were significantly associated with prefracture function and Mini Mental State Examination (MMSE) score (P=0.002 and P=0.01, respectively). The authors observed a significant positive correlation between serum hemoglobin and total FIM at discharge (Pearson's coefficient =0.13; P=0.005) as well as with motor FIM at discharge (Pearson's coefficient =0.13; P=0.005). Regression analyses showed that high MMSE scores (beta=0.55; P<0.001), female gender (beta=0.07; P=0.01), younger age (beta=-0.10, P=0.001) and a better pre-fracture function (beta=-0.27 P<0.001) are associated with higher total FIM scores upon discharge. Neither discharge hemoglobin levels nor the number of transfused blood packs were significantly associated with better total FIM, motor FIM, FIM gain or FIM= or >80.scores.
Higher hemoglobin at discharge was not associated with a better postfracture function, as reflected by FIM scores. The authors suggest that clinically reasonable low hemoglobin levels are not associated with adverse functional outcome of elderly hip fracture patients, thus, actively correcting hemoglobin levels, per se, may not result in better functional outcomes in this population.
低血红蛋白水平被认为是功能预后不良的一个指标。本研究的目的是探讨老年髋部骨折患者在住院康复期间出院时血红蛋白水平与功能预后之间的可能关系。
一项回顾性图表审查研究，纳入连续的创伤性髋部骨折老年患者。主要结局指标是患者的功能预后，通过入院和出院时的运动功能和总功能独立性测量（FIM）评分进行评估。
出院时平均血红蛋白水平与骨折前功能和简易精神状态检查表（MMSE）评分显著相关（分别为P = 0.002和P = 0.01）。作者观察到出院时血清血红蛋白与总FIM之间存在显著正相关（Pearson系数 = 0.13；P = 0.005），以及与出院时的运动FIM之间存在显著正相关（Pearson系数 = 0.13；P = 0.005）。回归分析表明，高MMSE评分（β = 0.55；P < 0.001）、女性（β = 0.07；P = 0.01）、较年轻年龄（β = -0.10，P = 0.001）和更好的骨折前功能（β = -0.27，P < 0.001）与出院时更高的总FIM评分相关。出院时的血红蛋白水平和输血包数量均与更好的总FIM、运动FIM、FIM增益或FIM = 或>80分无显著关联。
FIM评分反映，出院时较高的血红蛋白与骨折后更好的功能无关。作者认为，临床上合理的低血红蛋白水平与老年髋部骨折患者的不良功能预后无关，因此，在该人群中单纯积极纠正血红蛋白水平可能不会导致更好的功能预后。
