预后营养指数（PNI）是老年髋部骨折患者功能结局的独立预测因子：一项前瞻性队列研究。
Prognostic nutritional index (PNI) is an independent predictor for functional outcome after hip fracture in the elderly: a prospective cohort study.
机构信息
Department of Orthopedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing, China.
Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
出版信息
Arch Osteoporos. 2024 Nov 5;19(1):107. doi: 10.1007/s11657-024-01469-1.
UNLABELLED
The prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures.
PURPOSE
To investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery.
METHODS
We prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 10/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively.
RESULTS
Of 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95% CI 1.10-2.61, P.adj = 0.017), while no significant differences were observed at other follow-ups. Additionally, patients in the higher PNI group had a significantly higher EQ-5D utility value at the 30-day follow-up (P.adj = 0.015). A linear regression model with adjusting for all confounders showed that admission PNI value was positively associated with EQ-5D utility values at 30-day, 120-day, and 1-year follow-up assessments (P.adj = 0.011, P.adj = 0.001, and P.adj = 0.030, respectively). However, this correlation was not observed at the 3-year time point (P.adj = 0.079).
CONCLUSION
The PNI is a valuable predictor of functional outcomes in elderly patients with hip fractures following surgery.
不具名
预后营养指数（PNI）是一种使用血清白蛋白和淋巴细胞计数评估营养状况的有用工具。本研究表明，术前较高的 PNI 与老年髋部骨折患者术后初期活动能力和健康相关生活质量的改善相关。
目的
探讨预后营养指数（PNI）预测老年髋部骨折患者术后活动能力和健康相关生活质量（HRQoL）的预后价值。
方法
我们前瞻性纳入了 2018 年至 2019 年间年龄在 65 岁及以上、受伤前能自由行走且接受手术的患者。入院时 PNI 计算为血清白蛋白（g/L）+5×总淋巴细胞计数（×10/L）。根据 PNI 中位数将患者分为两组。所有患者均通过电话随访 4 次（术后 30 天、120 天、1 年和 3 年）。采用骨折活动评分（FMS）和欧洲五维健康量表 5 维度 5 水平（EQ-5D 5L）分别评估活动能力和 HRQoL。
结果
在 705 名符合条件的患者中，487 名完成了所有评估。较高 PNI 组患者在 120 天随访时达到无限制活动的可能性显著增加（OR 1.69，95%CI 1.10-2.61，P.adj=0.017），而在其他随访时间点则无显著差异。此外，较高 PNI 组患者在 30 天随访时的 EQ-5D 效用值显著更高（P.adj=0.015）。在调整所有混杂因素的线性回归模型中，入院时 PNI 值与 30 天、120 天和 1 年随访时的 EQ-5D 效用值呈正相关（P.adj=0.011、P.adj=0.001 和 P.adj=0.030）。然而，在 3 年时间点未观察到这种相关性（P.adj=0.079）。
结论
PNI 是预测老年髋部骨折患者手术后功能结局的有价值指标。
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