Clinica Medica, Clinical Department of Medical, Surgical and Health Sciences, University Hospital of Trieste, Strada di Fiume 447, 34100 Trieste, Italy.
Geriatria, Department of Medicine, University Hospital of Trieste, Piazza dell'Ospitale 1, 34100 Trieste, Italy.
Nutrients. 2022 Feb 16;14(4):820. doi: 10.3390/nu14040820.
Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality.
We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI).
The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher ( < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased ( = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality.
Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.
高渗性脱水（HD）是老年髋部骨折患者发生严重并发症的危险因素。然而，推荐脱水筛查的证据不足，其与虚弱和死亡率的关系尚不清楚。我们检验了术后 HD 与虚弱和死亡率增加相关的假设。
我们招募了 2017 年一年内在一个骨科老年医学团队共同管理的 625 名年龄较大（>65 岁）接受髋关节骨折手术治疗的患者。诊断术前和术后 HD（血清渗透压>300mmol/L）。使用多维预后指数（MPI）评估虚弱和相关死亡风险。
术前 HD 的患病率为 20.4%。与非 HD 患者相比，尽管 HD 患者的多药治疗、动脉高血压、糖尿病、慢性肾脏病和心力衰竭的患病率更高（<0.05），但 MPI 相似。手术后 HD 的发病率下降到 16.5%，但在 MPI 高危亚组中增加（=0.003）。术后 HD 与更多并发症相关，是调整后的住院时间（LOS）和 60-365 天死亡率的独立决定因素。
患有髋部骨折的老年虚弱患者易发生术后 HD，这独立预测住院时间延长和死亡率增加。系统筛查老年患者的虚弱和脱水情况，以便为高危个体定制水化管理是明智的。
