Department of Internal Medicine, CARIM, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Department of Orthopaedic Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Osteoporos Int. 2024 Jul;35(7):1273-1287. doi: 10.1007/s00198-024-07088-3. Epub 2024 May 17.
We determined the prognostic value of nutritional status for outcome after hip fracture. Nutritional status was a strong independent prognostic factor for clinical outcome and 5-year mortality. Physical function showed incomplete recovery. Elderly care should focus on prevention already before hip fracture.
To determine the prognostic value of nutritional status in hip fracture patients for multiple clinical and functional outcomes over 6 months, and for new fractures and survival over 5 years post-fracture.
We included 152 well-characterized subjects (age 55+ years) with a hip fracture from a previously published randomized controlled trial. Nutritional status was appraised using the Mini Nutritional Assessment (MNA). Multivariable linear, logistic and Cox regression models were fitted, adjusted for age, sex, ASA score, group and additional prognostic covariates identified in backward regression models.
At baseline, impaired nutritional status was significantly associated with physical disability, depression, impaired cognition and lower quality of life. Prospective analyses showed that impaired baseline nutritional status was an independent prognostic factor for postoperative complications (OR 2.00, 95%CI 1.01-3.98, p = 0.047), discharge location from hospital (home vs. rehabilitation clinic, OR 0.41, 95%CI 0.18-0.98, p = 0.044), hospital readmission (OR 4.59, 95%CI 1.70-12.4, p = 0.003) and total length of hospital stay (HR of being discharged: 0.63, 96%CI 0.44-0.89, p = 0.008), as well as for 5-year mortality (HR 3.94, 95%CI 1.53-10.2, p = 0.005), but not for risk of new fractures (5y-HR 0.87, 95%CI 0.34-2.24, p = 0.769). Curves of physical disability over time showed that the three nutritional status categories followed almost parallel trajectories from baseline until 6 months after hip fracture, without complete recovery and even with further deterioration in malnourished subjects from 3 to 6 months post-fracture.
As baselline nutritional status is a strong independent prognostic factor for clinical outcome after hip fracture, affecting even five-year survival, elderly health care should focus on prevention and identification of at-risk individuals already before hip fracture.
我们确定了营养状况对髋部骨折后结局的预后价值。营养状况是临床结局和 5 年死亡率的一个强有力的独立预后因素。身体功能的恢复并不完全。老年护理应在髋部骨折之前就开始关注预防。
确定营养状况在髋部骨折患者中的预后价值，以预测 6 个月内的多项临床和功能结局，并预测 5 年内的新发骨折和生存率。
我们纳入了来自先前发表的一项随机对照试验的 152 名特征明确的（年龄≥55 岁）髋部骨折患者。使用迷你营养评估（MNA）评估营养状况。使用多变量线性、逻辑和 Cox 回归模型进行拟合，调整了年龄、性别、ASA 评分、组和向后回归模型中确定的其他预后协变量。
基线时，营养状况受损与身体残疾、抑郁、认知障碍和生活质量下降显著相关。前瞻性分析显示，基线营养状况受损是术后并发症（OR 2.00，95%CI 1.01-3.98，p=0.047）、出院地点（从医院出院回家 vs. 康复诊所，OR 0.41，95%CI 0.18-0.98，p=0.044）、医院再入院（OR 4.59，95%CI 1.70-12.4，p=0.003）和总住院时间（出院的 HR：0.63，96%CI 0.44-0.89，p=0.008）的独立预后因素，以及 5 年死亡率（HR 3.94，95%CI 1.53-10.2，p=0.005），但与新发骨折风险无关（5 年 HR 0.87，95%CI 0.34-2.24，p=0.769）。身体残疾随时间变化的曲线表明，在髋部骨折后 6 个月内，三个营养状况类别几乎平行地从基线发展，没有完全恢复，甚至在营养不足的患者从骨折后 3 个月到 6 个月时进一步恶化。
由于基线营养状况是髋部骨折后临床结局的一个强有力的独立预后因素，甚至影响到 5 年生存率，因此老年医疗保健应在髋部骨折之前就开始关注预防和识别高危人群。
