Laboratory nutritional parameters predict one-year mortality in elderly patients with intertrochanteric fracture

血液营养指标能够预测高龄股骨粗隆间骨折患者术后一年死亡率

Jun Lu ； Yuan-Yuan Chen ； Lin Zhang ； Yong-Gang Li ； Chen Wang

《Asia Pacific Journal of Clinical Nutrition》 25卷3期 (2016/09) Pp. 457-463

https://doi.org/10.6133/apjcn.092015.04

摘要

背景和目的：观察术前营养相关的血液指标对中国65岁以上股骨粗隆间骨折患者内固定术后一年死亡率的预测价值。方法和研究设计：将入院时患者血清白蛋白水平及全血淋巴细胞计数作为评价患者营养状况的主要指标，共174例高龄股骨粗隆间骨折患者纳入了本项研究并进行了营养评估，采用单变量分析方法比较营养指标的性别差异，采用多变量logistic 回归分析评估不同指标对患者术后一年死亡率的预测价值。结果：术前平均白蛋白水平为31.0 g/L，其中73%的患者低于正常水平35 g/L；术前平均淋巴细胞计数水平为1.19×10^9cells/L，其中81%的患者低于正常水平1.50×10^9 cells/L。不同性别患者的白蛋白和淋巴细胞计数没有显著差异，接受手术治疗并获得最终随访的149 例患者，总体死亡率为31%，其中男性患者为35%，女性患者为29%。相对于死亡的患者，存活的患者更年轻、术前具有更高的白蛋白、淋巴细胞计数和血钙水平。然而多因素回归分析显示只有白蛋白水平和淋巴细胞计数是预测患者一年内死亡的独立危险因素。受试者操作特征曲线显示白蛋白和淋巴细胞计数两项指标的临界值分别为29.5 g/L 和0.925×10^9 cells/L。结论：营养不良在中国高龄股骨粗隆间骨折人群中是一个普遍现象。患者入院时的血清白蛋白水平和血液淋巴细胞计数对患者术后一年的死亡率具有预测价值。

關鍵字

营养状况 ； 股骨粗隆间骨折 ； 死亡率 ； 老年人 ； 白蛋白

並列摘要

Background and Objectives: The purpose of this study was to investigate the contributing value of nutrition related blood parameters to one-year mortality following intertrochanteric fracture surgery in a Chinese population over the age of 65. Methods and Study Design: Nutritional status was evaluated by using admission serum albumin and total lymphocyte count (TLC). One hundred and seventy-four intertrochanteric fracture patients were entered into this study for nutritional status assessment. Gender differences were evaluated by univariate analysis. The predictive value of the variables for one-year mortality was assessed by multiple logistic regression analysis. Results: The mean albumin was 31.0 g/L with 73% of patients less than 35 g/L and the mean TLC was 1.19×10^9 cells/L with 81% less than 1.50×10^9 cells/L. There were no significant differences in albumin (p=0.674) or TLC (p=0.804) between men and women. Survival information was obtained in 149 patients who received surgical treatment. The general one-year mortality was 31% with 35% in men and 29% in women, respectively. The surviving patients were younger and had higher albumin, TLC and calcium than those who died. However, multivariate analysis identified only serum albumin and TLC as independent and significant risk factors associated with one-year mortality; the optimal cut-off points were 29.5 g/L and 0.93×10^9 cells/L, respectively, based on the receiver operating characteristic (ROC) curve. Conclusions: Malnutrition is a common phenomenon in an aged Chinese population suffering from intertrochanteric fractures. A lower serum albumin level and total lymphocyte count at admission are significant risk factors to predict the one-year mortality.

並列關鍵字

nutritional status ； intertrochanteric fractures ； mortality ； elderly people ； albumin