Contribution of hypoalbuminemia and decreased renal function to the increased mortality after newly diagnosed vertebral fracture in Japanese subjects

日本新诊断椎体骨折患者低蛋白血症和肾功能下降对增加死亡率的贡献

Tetsuo Nakano ； Akiko Kuwabara ； Hiroshi Mizuta ； Kiyoshi Tanaka

《Asia Pacific Journal of Clinical Nutrition》 25卷3期 (2016/09) Pp. 472-477

https://doi.org/10.6133/apjcn.092015.17

摘要

背景与目的：关于椎体骨折（VFx）的报道仅限于患病率，而死亡率和影响因素的报道却很少。本文研究了新诊断的VFx死亡率的影响因素。方法和研究设计：本研究纳入背或腰椎疼痛，经MRI新诊断为VFx的759名患者（平均年龄为78.8±8.5岁）。记录了他们的年龄、性别、骨折发生的次数、生存或死亡的日期、循环血红蛋白的浓度、白蛋白、C反应蛋白和估计的肾小球滤过率（eGFR）。进行Cox比例风险分析，以评估死亡率有意义的预测指标。使用受试者工作特征曲线（ROC）分析死亡率预测指标的截点值。结果：中位观察时间为3.8年，3年生存率为78.8%。Cox比例风险分析表明血清白蛋白（危险比HR=0.355）浓度和eGFR（HR=0.993）是死亡率的重要预测指标，截点值分别为3.6 g/dL和60mL/min/1.73m^2。Kaplan-Meier 曲线显示，血清白蛋白浓度和eGFR都低于截点值的患者生存率显著降低。结论：目前的研究表明，营养不良和肾功能受损是VFx后死亡率的重要预测指标。

關鍵字

新发椎体骨折 ； 死亡率 ； 低蛋白血症 ； 肾功能

並列摘要

Background and Objectives: Reports on the mortality and its contributing factors after vertebral fracture (VFx) has been scarce, and limited to prevalent VFx. In this paper, we have studied the factors influencing mortality after freshly diagnosed VFx. Methods and Study Design: 759 subjects aged 78.8±8.5 years old with back or lumbar pain, and diagnosed as fresh VFx by MRI were studied for their age, gender, number of prevalent fracture (s), survival or the date of death, circulating concentrations of Hb, albumin, C reactive protein, and estimated glomerular filtration rate (eGFR). Cox’s proportional hazard analysis was performed to assess the significant predictors for mortality. The cut-off concentrations of the variables for mortality were analyzed using the receiver operator characteristic (ROC) curve. Results: The median observation duration was 3.8 years, and 3-year survival rate was 78.8%. Cox’s proportional hazard analysis has shown that serum albumin concentration (hazard ratio (HR) =0.355) and eGFR (HR=0.993) were significant predictors for mortality. The cut-off concentrations were 3.6 g/dL and 60 mL/min/1.73m^2, respectively. Kaplan-Meier curves revealed that survival rates were significantly decreased in patients with both serum albumin concentration and eGFR below these cut-off concentrations. Conclusions: The present study has revealed that malnutrition and impaired renal function were significant predictors for mortality after VFx.

並列關鍵字

fresh vertebral fracture ； MRI ； mortality ； hypoalbuminemia ； renal function