Harrison S J, Messner J, Leeder D J, Stephenson J, Sidhom S A
Simon J Harrison, Huddersfield Royal Infirmary, Acre Street, Huddersfield, HD3 3EA, United Kingdom,
J Nutr Health Aging. 2017;21(6):699-703. doi: 10.1007/s12603-016-0799-6.
Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (<35g/dl) has been highlighted as being a good biochemical predictor of short-term mortality (<12 months). Our aims were to assess whether there was an association between low albumin levels and mortality and whether the severity adversely affects outcomes.
Patients admitted to our large district hospital between January 2011 and December 2012 who had sustained a NOF fracture, were over 65 years old and had a pre-operative albumin level were included. This retrospective, longitudinal, observational study concluded in July 2014. Demographic and pre-operative function and albumin data was collated retrospectively. An association with mortality was made.
471 patients had usable data. Mean pre-operative albumin level was 29.5g/dl (SD 6.22g/dl) in patients who died and 32.8g/dl (SD 6.43g/dl) in patients who survived during the study period. Pre-operative albumin level was significantly associated with survival (hazard ratio 0.957: 95% CI (0.937, 0.978); p<0.001). Thus, a reduction of 1g/dl in pre-operative albumin is associated with an increased hazard of death of 4.3%.
Early identification of patients with hypoalbuminaemia on admission with a venous blood sample and timely input from orthogeriatrians could optimise these patients pre- and post-operatively. This may enable rates of morbidity and mortality to fall. Hypoalbuminaemia may be a reasonable predictor of shorter-term mortality in this patient subgroup. However, this may reflect existing co-morbidities rather than an isolated cause. This study supports an association between hypoalbuminaemia and poorer outcome for patients with NOF fractures.
股骨颈（NOF）骨折与患有多种合并症的老年人的高发病率和死亡率相关；这使得对该患者亚组的管理具有挑战性。因此，发病率和死亡率增加的预测因素将为评估和管理这一人群提供一个有用的框架。在当前文献中，低白蛋白血症（<35g/dl）已被强调为短期死亡率（<12个月）的良好生化预测指标。我们的目的是评估低白蛋白水平与死亡率之间是否存在关联，以及严重程度是否会对结果产生不利影响。
纳入2011年1月至2012年12月期间入住我们大型地区医院、发生NOF骨折、年龄超过65岁且有术前白蛋白水平的患者。这项回顾性、纵向、观察性研究于2014年7月结束。回顾性整理人口统计学、术前功能和白蛋白数据。分析其与死亡率的关联。
471例患者有可用数据。在研究期间，死亡患者的术前平均白蛋白水平为29.5g/dl（标准差6.22g/dl），存活患者为32.8g/dl（标准差6.43g/dl）。术前白蛋白水平与生存率显著相关（风险比0.957：95%置信区间（0.937，0.978）；p<0.001）。因此，术前白蛋白水平每降低1g/dl，死亡风险增加4.3%。
入院时通过静脉血样本早期识别低白蛋白血症患者，并及时获得老年骨科医生的意见，可以优化这些患者的术前和术后情况。这可能使发病率和死亡率降低。低白蛋白血症可能是该患者亚组短期死亡率的合理预测指标。然而，这可能反映了现有的合并症，而非单一原因。本研究支持低白蛋白血症与NOF骨折患者预后较差之间存在关联。
