Department of Rehabilitation, Wakakusa-Tatsuma Rehabilitation Hospital, 1580 Ooaza Tatsuma, Daito City, Osaka, 574-0012, Japan.
Department of Physical Therapy, Konan Women's University, 6-2-23 Morikita-cho, Higashinada-ku, Kobe City, Hyogo, 658-0001, Japan.
Clin Nutr ESPEN. 2021 Aug;44:356-366. doi: 10.1016/j.clnesp.2021.05.014. Epub 2021 May 25.
BACKGROUND & AIMS: Heart failure and malnutrition are known to each negatively affect a patient's ability to improve their activities of daily living (ADL) through rehabilitation. Here, we investigated whether the negative effects of malnutrition and heart failure on ADL are additive in patients after hip fracture.
This retrospective observational cohort study included 155 patients with hip fracture admitted to convalescent rehabilitation wards. Nutritional status was measured with the Geriatric Nutritional Risk Index (GNRI). Heart failure was assessed using plasma B-type natriuretic peptide (BNP) levels. Based on their GNRIs and BNP levels, patients were classified into four groups: a high GNRI (≥92)-low BNP (<100 pg/ml) group (n = 54); high GNRI-high BNP (≥100 pg/ml) group (n = 7); low GNRI (<92)-low BNP group (n = 67); and low GNRI-high BNP group (n = 27). The main outcome was rehabilitation effectiveness (REs). To confirm above hypothesis, heart failure was also assessed by American College of Cardiology/American Heart Association (ACC/AHA) stage classification, whereas nutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), either.
REs in the high GNRI-low BNP group, high GNRI-high BNP group, low GNRI-low BNP group, and low GNRI-high BNP group were 64.8 ± 22.6%, 36.0 ± 22.0%, 40.6 ± 23.6% and 28.5 ± 25.9%, respectively. REs was higher in the high GNRI-low BNP group than in other three groups, and REs in the low GNRI-low BNP group was higher than in the low GNRI-high BNP group. When we evaluated heart failure by ACC/AHA stage classification instead of BNP, or evaluated nutrition by MNA-SF instead of GNRI, the similar results were demonstrated. Multiple linear regression analyses revealed that age (p < 0.01), handgrip strength (p < 0.01), GNRI (p < 0.05), and BNP (p < 0.01) were significantly associated with REs.
These results suggest that malnutrition and heart failure are independently associated with REs and that they have an additive negative effect on improvement of ADL in elderly patients with hip fractures.
心力衰竭和营养不良已知会对患者通过康复改善日常生活活动（ADL）的能力产生负面影响。在这里，我们研究了营养不良和心力衰竭对髋部骨折后患者 ADL 的负面影响是否具有累加效应。
本回顾性观察队列研究纳入了 155 名入住康复病房的髋部骨折患者。使用老年营养风险指数（GNRI）测量营养状况。使用血浆 B 型利钠肽（BNP）水平评估心力衰竭。根据他们的 GNRI 和 BNP 水平，患者被分为四组：高 GNRI（≥92）-低 BNP（<100pg/ml）组（n=54）；高 GNRI-高 BNP（≥100pg/ml）组（n=7）；低 GNRI（<92）-低 BNP 组（n=67）；和低 GNRI-高 BNP 组（n=27）。主要结局是康复效果（RE）。为了证实上述假设，还通过美国心脏病学会/美国心脏协会（ACC/AHA）分期分类评估心力衰竭，通过迷你营养评估简表（MNA-SF）评估营养状况。
高 GNRI-低 BNP 组、高 GNRI-高 BNP 组、低 GNRI-低 BNP 组和低 GNRI-高 BNP 组的 RE 分别为 64.8±22.6%、36.0±22.0%、40.6±23.6%和 28.5±25.9%。高 GNRI-低 BNP 组的 RE 高于其他三组，低 GNRI-低 BNP 组的 RE 高于低 GNRI-高 BNP 组。当我们用 ACC/AHA 分期分类代替 BNP 评估心力衰竭，或用 MNA-SF 代替 GNRI 评估营养状况时，得到了相似的结果。多元线性回归分析表明，年龄（p<0.01）、握力（p<0.01）、GNRI（p<0.05）和 BNP（p<0.01）与 RE 显著相关。
这些结果表明，营养不良和心力衰竭与 RE 独立相关，它们对老年髋部骨折患者 ADL 的改善具有累加的负面影响。
