Gregersen Merete, Borris Lars Carl, Damsgaard Else Marie
Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
J Am Med Dir Assoc. 2015 Sep 1;16(9):762-6. doi: 10.1016/j.jamda.2015.03.022. Epub 2015 Apr 28.
We examined possible associations between different red blood cell (RBC) transfusion strategies, overall quality of life (OQoL), and recovery of activities of daily living (ADL) in operated frail elderly hip fracture patients, and the possibility that OQoL was related to ADL recovery.
A prospective, assessor-blinded, randomized controlled trial was carried out among 157 elderly residents (≥65 years) from nursing homes and sheltered housing facilities with Mini-Mental State Examination scores ≥5 points. Patients were assigned to either a restrictive RBC transfusion strategy [hemoglobin (Hb) < 9.7 g/dL, 6 mmol/L] or a liberal strategy (Hb < 11.3 g/dL, 7 mmol/L) during the first 30 days after surgery. An interview-based questionnaire, the depression list (DL) assessing OQoL, and the modified Barthel Index (MBI) assessing ADL performance, were conducted on day 30 and 1 year after hip fracture surgery. Sum-scores of DL, MBI, and their changes from day 30 until 1 year (expressing recovery) were compared between RBC transfusion groups. Possible associations between changes of DL and MBI sum-scores were tested for across total patient population.
There was no association between OQoL and RBC transfusion strategies on day 30 or at 1 year. The DL sum-score changes were similar for both groups, (ie, 1.06 points) [95% confidence interval (CI) -0.62, 2.76)] P = .21. The MBI sum-scores increased at 1 year following the liberal transfusion strategy (ie, by 6.86 points) (95% CI 0.41, 13.3) P = .03. Recoveries of OQoL and ADL were associated: β = -0.06 (95% CI -0.11, -0.01) P = .02.
According to our Hb threshold criteria, OQoL and RBC transfusion strategies for frail elderly hip fracture patients are not associated. However, for survivors with less severe dementia, ADL recovery after 1 year is greater following a liberal transfusion strategy than a restrictive strategy. OQoL progress and ADL recovery were associated.
我们研究了不同红细胞（RBC）输血策略、总体生活质量（OQoL）以及老年体弱髋部骨折手术患者日常生活活动（ADL）恢复之间的可能关联，以及OQoL与ADL恢复相关的可能性。
对157名来自养老院和庇护性住房设施、简易精神状态检查表得分≥5分的65岁及以上老年居民进行了一项前瞻性、评估者盲法、随机对照试验。患者在术后前30天被分配至限制性RBC输血策略组（血红蛋白（Hb）<9.7 g/dL，6 mmol/L）或宽松策略组（Hb<11.3 g/dL，7 mmol/L）。在髋部骨折手术后第30天和1年，采用基于访谈的问卷、评估OQoL的抑郁量表（DL）和评估ADL表现的改良Barthel指数（MBI）进行调查。比较RBC输血组之间DL、MBI的总分及其从第30天到1年的变化（表示恢复情况）。对全体患者测试DL和MBI总分变化之间的可能关联。
在第30天或1年时，OQoL与RBC输血策略之间无关联。两组的DL总分变化相似（即1.06分）[95%置信区间（CI）-0.62，2.76]，P = 0.21。采用宽松输血策略的患者在1年后MBI总分增加（即增加6.86分）（95%CI 0.41，13.3），P = 0.03。OQoL和ADL的恢复相关：β = -0.06（95%CI -0.11，-0.01），P = 0.02。
根据我们的Hb阈值标准，老年体弱髋部骨折患者的OQoL与RBC输血策略无关。然而，对于痴呆程度较轻的幸存者，采用宽松输血策略1年后的ADL恢复情况比限制性策略更好。OQoL进展与ADL恢复相关。
