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Guo L, Zhang N, Fan X, Hou X, Li M, Xu W, Liu P, Xing L, Wang J, Chen S, Wu S, Tian F. The effect of hypersensitive C-reactive protein to albumin ratio on the risk of fragility fracture in the Chinese male population. Osteoporos Int 2025; 36:685-694. [PMID: 39982456 DOI: 10.1007/s00198-025-07428-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 02/08/2025] [Indexed: 02/22/2025]
Abstract
This study explored the association between the hypersensitive C-reactive protein to albumin ratio (CAR) and fragility fractures in Chinese males. Results show that elevated levels of CAR were associated with an increased risk of fragility fractures and that this association was robust to adjustment for multiple potential confounders. PURPOSE This study investigates the relationship between the hypersensitive C-reactive protein to albumin ratio (CAR) and fragility fractures in a Chinese male population. METHODS A total of 48,186 male participants (age range 18-98 years old, average age 53.92 years) at baseline were recruited from the Kailuan Study and followed up for outcomes until 2022. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident fragility fractures. The dose response between CAR and fracture risk was analyzed using restricted cubic splines. Additionally, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were utilized to assess the incremental predictive value of various indicators for the discrimination of fragility fractures. RESULTS During an average follow-up of 11.17 years, 728 incident fragility fractures occurred among the 48,186 participants. Compared to participants in the second quartile of CAR, those in the highest quartile had a 49% increased risk of fragility fractures (HR = 1.49, 95% CI = 1.21-1.84) after adjusting for risk factors. Restricted cubic spline analysis showed a nonlinear relationship between CAR and the risk of fragility fractures. The C-index, continuous NRI, and IDI for predicting the risk of fragility fractures were 61.142%, 0.089 (p < 0.05), and 0.00009 (p < 0.05), respectively, which were higher than those of hs-CRP (C-index 0.6137, NRI 0.086, IDI 0.000074) and albumin (C- index 0.6116, NRI 0.068, IDI - 0.000004). CONCLUSION Elevated levels of CAR were associated with an increased risk of fragility fractures and that this association was robust to adjustment for multiple potential confounders.
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Affiliation(s)
- Lu Guo
- School of Public Health, Hebei Key Laboratory for Organ Fibrosis Research, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis. Tangshan, 063200, Hebei, China
| | - Nan Zhang
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Xinhao Fan
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Xiaoli Hou
- School of Public Health, Hebei Key Laboratory for Organ Fibrosis Research, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis. Tangshan, 063200, Hebei, China
| | - Man Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenqi Xu
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peipei Liu
- School of Public Health, Hebei Key Laboratory for Organ Fibrosis Research, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis. Tangshan, 063200, Hebei, China
| | - Lei Xing
- Department of General Practice, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Jingyao Wang
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Shuohua Chen
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Shouling Wu
- Kailuan General Hospital, Tangshan, Hebei, China.
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, No.57 Xinhua East Street, Tangshan, 063200, China.
| | - Faming Tian
- School of Public Health, Hebei Key Laboratory for Organ Fibrosis Research, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis. Tangshan, 063200, Hebei, China.
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Hsu SY, Rau CS, Tsai CH, Chou SE, Su WT, Hsieh CH. Association of easy albumin-bilirubin score with increased mortality in adult trauma patients. Front Surg 2024; 11:1280617. [PMID: 38721021 PMCID: PMC11076689 DOI: 10.3389/fsurg.2024.1280617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/09/2024] [Indexed: 01/03/2025] Open
Abstract
INTRODUCTION The easy albumin-bilirubin (EZ-ALBI) score is calculated using the equation: total bilirubin (mg/dl) - 9 × albumin (g/dl), and is used to evaluate liver functional reserve. This study was designed to investigate whether the EZ-ALBI score serves as an independent risk factor for mortality and is useful for stratifying the mortality risk in adult trauma patients. METHODS We retrospectively reviewed data from the registered trauma database of the hospital and included 3,637 adult trauma patients (1,241 deaths and 2,396 survivors) due to all trauma caused between January 1, 2009, and December 31, 2021. The patients were allocated to the two study groups based on the best EZ-ALBI cutoff point (EZ-ALBI = -28.5), which was determined based on the area under the receiver operating characteristic curve. RESULTS Results revealed that the non-survivors had a significantly higher EZ-ALBI score than the survivors (-26.4 ± 6.5 vs. -31.5 ± 6.2, p < 0.001). Multivariate logistic regression analysis revealed that EZ-ALBI ≥ -28.5was an independent risk factor for mortality (odds ratio, 2.31; 95% confidence interval, 1.63-3.28; p < 0.001). Patients with an EZ-ALBI score ≥ -28.5 presented with 2.47-fold higher adjusted mortality rates than patients with an EZ-ALBI score < -28.5. A propensity score-matched pair cohort of 1,236 patients was developed to reduce baseline disparities in trauma mechanisms. The analysis showed that patients with an EZ-ALBI score ≥ -28.5 had a 4.12 times higher mortality rate compared to patients with an EZ-ALBI score < -28.5. CONCLUSION The EZ-ALBI score was a significant independent risk factor for mortality and can serve as a valuable tool for stratifying mortality risk in adult trauma patients by all trauma causes.
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Affiliation(s)
- Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Liang B, Shi X, Wang X, Ma C, Leslie WD, Lix LM, Shi X, Kan B, Yang S. Association between amino acids and recent osteoporotic fracture: a matched incident case-control study. Front Nutr 2024; 11:1360959. [PMID: 38567247 PMCID: PMC10985241 DOI: 10.3389/fnut.2024.1360959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Context Osteoporotic fracture is a major public health issue globally. Human research on the association between amino acids (AAs) and fracture is still lacking. Objective To examine the association between AAs and recent osteoporotic fractures. Methods This age and sex matched incident case-control study identified 44 recent x-ray confirmed fracture cases in the Second Hospital of Jilin University and 88 community-based healthy controls aged 50+ years. Plasma AAs were measured by high performance liquid chromatography coupled with mass spectrometry. After adjusting for covariates (i.e., body mass index, milk intake >1 time/week, falls and physical activity), we conducted conditional logistical regression models to test the association between AAs and fracture. Results Among cases there were 23 (52.3%) hip fractures and 21 (47.7%) non-hip fractures. Total, essential, and non-essential AAs were significantly lower in cases than in controls. In the multivariable conditional logistic regression models, after adjusting for covariates, each standard deviation increase in the total (odds ratio [OR]: 0.304; 95% confidence interval [CI]: 0.117-0.794), essential (OR: 0.408; 95% CI: 0.181-0.923) and non-essential AAs (OR: 0.290; 95%CI: 0.107-0.782) was negatively associated with recent fracture. These inverse associations were mainly found for hip fracture, rather than non-hip fractures. Among these AAs, lysine, alanine, arginine, glutamine, histidine and piperamide showed the significantly negative associations with fracture. Conclusion There was a negative relationship between AAs and recent osteoporotic fracture; such relationship appeared to be more obvious for hip fracture.
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Affiliation(s)
- Bing Liang
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi’an Jiao tong University, Xi’an, China
| | - Xinyan Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinwei Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Chao Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - William D. Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xianbao Shi
- Department of Pharmacy, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Bo Kan
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Shuman Yang
- Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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Koudouna S, Evangelopoulos DS, Sarantis M, Chronopoulos E, Dontas IA, Pneumaticos S. The Effect of Postoperative Physical Therapy Following Hip Fracture: A Literature Review. Cureus 2023; 15:e37676. [PMID: 37206486 PMCID: PMC10189836 DOI: 10.7759/cureus.37676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
Hip fractures in the elderly have become a major public health concern as the population ages. Post-operative rehabilitation is associated with improved outcomes and a greater likelihood of returning to pre-operative functional capacity. Several studies have been conducted to investigate various post-operative recovery pathways. However, little is known about which post-operative rehabilitation pathways for hip fractures are most effective in improving patient outcomes. No clear evidence-based guidelines for a standard mobilization protocol for patients are currently available. This review aims to investigate post-operative recovery pathways to help patients suffering from hip fracture return to pre-fracture condition and to quantify pre-operative and post-operative scores for objective rehabilitation evaluation. Measuring pre-operative activity and comparing it to post-operative follow-up values can help predict post-operative rehabilitation functional outcomes.
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Affiliation(s)
- Smaragda Koudouna
- Department of Physiotherapy, General Hospital of Attika 'KAT', Athens, GRC
| | - Dimitrios S Evangelopoulos
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
| | - Michail Sarantis
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
| | - Efstathios Chronopoulos
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
- Department of Orthopedic Surgery, Laboratory for Research of the Musculoskeletal System (LRMS) of the School of Medicine, University of Athens, Athens, GRC
| | - Ismene A Dontas
- Department of Veterinary Medicine, Laboratory for Research of the Musculoskeletal System (LRMS) of the School of Medicine, University of Athens, Athens, GRC
- Department of Veterinary Medicine, General Hospital of Attika 'KAT', Athens, GRC
- Department of Veterinary Medicine, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
| | - Spiros Pneumaticos
- 4th Department of Orthopedic Surgery, General Hospital of Attika 'KAT', Athens, GRC
- 3rd Department of Orthopedic Surgery, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, GRC
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Nam NH, Minh ND, Hai TX, Sinh CT, Loi CB, Anh LT. Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures. Malays Orthop J 2023; 17:10-17. [PMID: 37064636 PMCID: PMC10103916 DOI: 10.5704/moj.2303.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/18/2022] [Indexed: 04/18/2023] Open
Abstract
Introduction This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture. Materials and methods Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients' data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model. Results The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 - 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 - 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 - 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found. Conclusion Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.
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Affiliation(s)
- NH Nam
- Department of Orthopaedics, Nghe An Orthopaedic and Trauma Hospital, Nghe An, Vietnam
| | - ND Minh
- Department of Orthopaedics, National Hospital of Acupuncture, Ha Noi, Vietnam
| | - TX Hai
- Department of Pediatrics, Nghe An Obstetrics and Pediatrics Hospital, Nghe An, Vietnam
| | - CT Sinh
- Department of Orthopaedics Vinh Medical University, Nghe An, Vietnam
| | - CB Loi
- Department of Parasitology, National Institute of Malariology, Parasitology and Entomology
| | - LT Anh
- Department of Parasitology, Vietnam Military Medical University, Hanoi, Vietnam
- Corresponding Author: Le Tran Anh, Department of Parasitology, Vietnam Military Medical University, No. 160, Phung Hung Street, Phuc La Ward, Hadong District, Hanoi, Vietnam
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Chen X, Zhang J, Lin Y, Liu Z, Sun T, Wang X. Risk factors for postoperative mortality at 30 days in elderly Chinese patients with hip fractures. Osteoporos Int 2022; 33:1109-1116. [PMID: 34993561 DOI: 10.1007/s00198-021-06257-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED Arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery. It is important to improve short-term survival rates by optimizing the respiratory and cardiac function of geriatric patients before they undergo surgery. INTRODUCTION This study aims to investigate the 30-day mortality and related risk factors for elderly patients following surgery for hip fractures. METHODS This retrospective study examined chart reviews for evaluating associations of gender, age, fracture site, biochemical indicators, pre-surgery comorbidities, number of pre-surgery comorbidities, time to surgery and anesthesia and surgery methods with postoperative 30-day mortality in elderly hip fracture surgery patients. RESULTS A total of 1,004 patients were included in the study and 43 (4.3%) patients died within 30 days after surgery. Univariate analysis showed that patients in the non-survival group had a higher mean age, higher leukocyte counts, lower hemoglobin and albumin levels, a higher proportion of arrhythmias, pneumoniae and cardiac insufficiency and number of presurgical comorbidities than the survival group (all P-values < 0.05). Multivariate logistic analysis further confirmed that arrhythmia (OR = 2.033, P = 0.038), pneumonia (OR = 2.246, P = 0.041), cardiac insufficiency (OR = 2.833, P = 0.029), high leukocyte count (OR = 1.139, P = 0.009), and low albumin (OR = 0.925, P = 0.041) were all significant risk factors for mortality 30 days after surgery. CONCLUSIONS This study demonstrates that arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery.
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Affiliation(s)
- X Chen
- Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - J Zhang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - Y Lin
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - Z Liu
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - T Sun
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - X Wang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China.
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Sim SD, Sim YE, Tay K, Howe TS, Png MA, Chang CCP, Abdullah HR, Koh JSB. Preoperative hypoalbuminemia: Poor functional outcomes and quality of life after hip fracture surgery. Bone 2021; 143:115567. [PMID: 32745690 DOI: 10.1016/j.bone.2020.115567] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
AIMS Hip fracture patients have severe deterioration of their quality of life and function after their injury. Markers of malnutrition such as low albumin and low body mass index (BMI) have been shown to increase mortality and complication rates but their effect on recovery of quality of life and function after hip fracture surgery is unclear. The main aim of this paper is to further investigate if low albumin affects recovery after hip fracture surgery, while additionally studying low BMI as a possible risk factor for poor recovery. PATIENTS AND METHODS Retrospective analysis of 971 patients who underwent surgery for fragility hip fractures between January 2012 and December 2016 was performed. Demographic data, preoperative serum albumin and haemoglobin levels, BMI, Charlson Comorbidity Index (CCI), type of surgery (fixation vs replacement) and site of surgery were obtained. Patients were assessed using the Parker Mobility Scale (PMS), Harris Hip Score(HHS), Medical Outcomes Study 36-item Short-Form Health Survey (SF36) at pre-fracture, 6 weeks and 6 months after surgery. HHS was not available pre-operatively. Patients were grouped according to their albumin levels (low ≤35 g/L or normal) and BMI (underweight <18.5 or normal). Univariate and multivariate analyses were performed to examine the association between albumin and BMI and 6-month scores. RESULTS On univariate analysis, patients with low albumin ≤35 g/L had lower baseline PMS and SF36 Physical Functioning (PF) score. On multivariate analysis, preoperative hypoalbuminemia was associated with lower 6-month HHS, PMS and SF36 PF scores even after accounting for baseline scores and other confounders. BMI had no effect on 6-month scores. CONCLUSION Low albumin (≤35 g/L) is prevalent in elderly hip fracture patients and is associated with slower recovery of function and quality of life after surgery. Low albumin can be a useful prognostic tool to identify patients with poor recovery for further intervention or rehabilitation after hip fracture surgery.
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Affiliation(s)
- Shaoen David Sim
- Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Yilin Eileen Sim
- Singapore General Hospital, Outram Rd, Singapore 169608, Singapore
| | - Kenny Tay
- Singapore General Hospital, Outram Rd, Singapore 169608, Singapore
| | - Tet Sen Howe
- Singapore General Hospital, Outram Rd, Singapore 169608, Singapore
| | - Meng Ai Png
- Singapore General Hospital, Outram Rd, Singapore 169608, Singapore
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van der Sijp MPL, Suchiman HED, Eijk M, Vojinovic D, Niggebrugge AHP, Blauw GJ, Achterberg WP, Slagboom PE. The Prognostic Value of Metabolic Profiling in Older Patients With a Proximal Femoral Fracture. Geriatr Orthop Surg Rehabil 2020; 11:2151459320960091. [PMID: 33194255 PMCID: PMC7607756 DOI: 10.1177/2151459320960091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: High mortality rates of approximately 20% within 1 year after treatment are observed for patients with proximal femoral fractures. This preliminary study explores the prognostic value of a previously constructed mortality risk score based on a set of 14 metabolites for the survival and functional recovery in patients with proximal femoral fractures. Materials and Methods: A prospective observational cohort study was conducted including patients admitted with a proximal femoral fracture. The primary outcome was patient survival, and the recovery of independence in activities of daily living was included as a secondary outcome. The mortality risk score was constructed for each patient and its prognostic value was tested for the whole population. Results: Data was available form 136 patients. The mean age of all patients was 82.1 years, with a median follow-up of 6 months. Within this period, 19.0% of all patients died and 51.1% recovered to their prefracture level of independence. The mortality score was significantly associated with mortality (HR, 2.74; 95% CI, 1.61-4.66; P < 0.001), but showed only a fair prediction accuracy (AUC = 0.68) and a borderline significant comparison of the mortality score tertile groups in survival analyses (P = 0.049). No decisive associations were found in any of the analyses for the functional recovery of patients. Discussion: These findings support the previously determined prognostic value of the mortality risk score. However, the independent prognostic value when adjusted for potential confounding factors is yet to be assessed. Also, a risk score constructed for this specific patient population might achieve higher accuracies for the prediction of survival and functional recovery. Conclusions: A modest prediction accuracy was observed for the mortality risk score in this population. More elaborate studies are needed to validate these findings and develop a tailored model for clinical purposes in this patient population.
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Affiliation(s)
| | - H Eka D Suchiman
- Leiden Universitair Medisch Centrum, Leiden, South Holland, Netherlands
| | - Monica Eijk
- Leiden Universitair Medisch Centrum, Leiden, South Holland, Netherlands
| | - Dina Vojinovic
- Leiden Universitair Medisch Centrum, Leiden, South Holland, Netherlands
| | | | - Gerard J Blauw
- Leiden Universitair Medisch Centrum, Leiden, South Holland, Netherlands
| | | | - P Eline Slagboom
- Leiden Universitair Medisch Centrum, Leiden, South Holland, Netherlands
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Initial functional recovery as a measure for rehabilitation outcome in post-acute hip fractured patients. Arch Gerontol Geriatr 2020; 89:104070. [DOI: 10.1016/j.archger.2020.104070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/29/2023]
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Abstract
As the silver tsunami hits the world, older patients with hip fractures are expected to increase to 6.3 million by the year 2050, of which the majority will occur in Asia. The estimated global cost of hip fractures in the year 2050 is estimated to reach U.S. $130 billion. Hence, in addition to implementation of prevention strategies, it is important to develop an optimal model of care for older patients with hip fracture to minimize the huge medical and socioeconomic burden, especially in rapidly aging nations. This review summarizes the complications of hip fractures, importance of comprehensive geriatric assessment, and multidisciplinary rehabilitation, as well as predictors of rehabilitation outcome in older patients with hip fracture.
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Ju JB, Zhang PX, Jiang BG. Risk Factors for Functional Outcomes of the Elderly with Intertrochanteric Fracture: A Retrospective Cohort Study. Orthop Surg 2020; 11:643-652. [PMID: 31456321 PMCID: PMC6712441 DOI: 10.1111/os.12512] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022] Open
Abstract
Objective To identify baseline factors relevant to functional outcomes and health‐related quality of life in the elderly with intertrochanteric fractures. Methods For the present study, 168 patients with intertrochanteric fracture who were assigned to different treatments between January 2016 and December 2017 were retrospectively selected. Hip function was assessed by Harris hip score (HHS), and health‐related quality of life was evaluated by Barthel index (BI) of activities of daily living (ADL) and EuroQol 5‐dimensions (EQ‐5D) score, respectively. Data were analyzed by t‐test, ANOVA, Pearson's correlation, χ2‐test, and multivariate linear regression. Results A total of 164 (97.6%) patients completed the follow‐up, with an average follow‐up time of 15.7 ± 6.9 months; 39 (23.8%) patients died during the follow‐up period and 125 (76.2%) patients were eligible for the functional analysis. HHS at final follow‐up of 125 patients was 71.8 ± 13.1, and the following were associated with hip functional recovery: age (−0.45, 95% confidence interval (CI) −0.73 to −0.18, P < 0.01), serum albumin (0.65, 95% CI 0.04 to 1.27, P < 0.05), and ADL at discharge (0.18, 95% CI 0.01 to 0.33, P < 0.05). The Barthel index at final follow up in this cohort was 80.2 ± 18.1, and multivariable linear regression analysis showed that age (−0.49, 95% CI −0.85 to −0.12; P < 0.05), ADL score at discharge (0.29, 95% CI 0.07 to 0.51; P < 0.05) and internal fixation (16.3, 95% CI 3.3 to 29.3; P < 0.05) were associated with ADL at final follow‐up. EQ‐5D at final follow‐up was 0.74 ± 0.2, with which HHS (0.012, 95% CI 0.011 to 0.013; P < 0.01) was positively associated. Conclusion We identify several baseline factors associated with hip functional outcome, health utility, and ADL in the elderly after an intertrochanteric fracture, of which we could modify mutable factors to achieve better outcomes. These findings could help to inform treatment and functional prognosis.
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Affiliation(s)
- Jia-Bao Ju
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
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Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord 2019; 20:568. [PMID: 31775693 PMCID: PMC6882152 DOI: 10.1186/s12891-019-2950-0] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.
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Affiliation(s)
- Bang Yu Xu
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore.
| | - Shi Yan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Lian Leng Low
- Department of Family Med & Continuing Care, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Farhad Fakhrudin Vasanwala
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
| | - Sher Guan Low
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
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Aquilani R, Zuccarelli Ginetto C, Rutili C, Pisano P, Pasini E, Baldissarro E, Verri M, Boschi F. Supplemented amino acids may enhance the walking recovery of elderly subjects after hip fracture surgery. Aging Clin Exp Res 2019; 31:157-160. [PMID: 29667153 DOI: 10.1007/s40520-018-0941-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate whether supplemented essential amino acids (EAAs) could enhance rehabilitation therapy (Rehab) for recovery of walking capacity in subjects after hip fracture surgery (HFS). Eighty-three elderly subjects with HFS (20 ± 11 days after acute trauma) were eligible for the study and randomized to receive Rehab only (Rehab; n = 27), Rehab + placebo (RP; n = 28) or Rehab + EAAs (RE 8 g/day; n = 28). The patients' walking capacity (m) was measured by 6-min walking distance (6MWD) at admission and at discharge (median 66 days after admission). All patient groups were treated with the same Rehab (2 sessions/day × 5 days/week). The results showed that the gain in 6MWD was higher in RE than in Rehab and RP (p = 0.034; p = 0.024). The study shows that EAA supplementation can enhance walking recovery rate in subjects with HFS.
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Affiliation(s)
- Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1, 27100, Pavia, Italy
| | - Carlo Zuccarelli Ginetto
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3, 20090, Vimodrone, Milano, Italy
| | - Carla Rutili
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3, 20090, Vimodrone, Milano, Italy
| | - Pietro Pisano
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3, 20090, Vimodrone, Milano, Italy
| | - Evasio Pasini
- Divisione di Riabilitazione Cardiologica, Centro Medico di Lumezzane, Istituti Clinici Scientifici "Maugeri", IRCCS, Via G. Mazzini, 129, 25065, Lumezzane, BS, Italy
| | - Eleonora Baldissarro
- Dipartimento di Medicina Fisica e Riabilitativa, Centro Medico di Nervi, Istituti Clinici Scientifici "Maugeri", IRCCS, Via Missolungi 14, 16167, Nervi, GE, Italy
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1, 27100, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14, 27100, Pavia, Italy.
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Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C. Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing 2018; 47:661-670. [PMID: 29668839 DOI: 10.1093/ageing/afy057] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective this systematic review aimed to identify immutable and modifiable prognostic factors of functional outcomes and their proposed mechanism after hip fracture surgery. Design systematic search of MEDLINE, Embase, CINAHL, PEDRO, OpenGrey and ClinicalTrials.gov for observational studies of prognostic factors of functional outcome after hip fracture among surgically treated adults with mean age of 65 years and older. Study selection, quality assessment, and data extraction were completed independently by two reviewers. The Quality in Prognosis Studies Tool was used for quality assessment and assigning a level of evidence to factors. Proposed mechanisms for reported associations were extracted from discussion sections. Results from 33 studies of 9,552 patients, we identified 25 prognostic factors of functional outcome after hip fracture surgery. We organised factors into groups: demographics, injury and comorbidities, body composition, complications, and acute care. We assigned two factors a weak evidence level-anaemia and cognition. We assigned Parkinson's disease an inconclusive evidence level. We could not assign an evidence level to the remaining 22 factors due to the high risk of bias across studies. Frailty was the proposed mechanism for the association between anaemia and functional outcome. Medication management, perceived potential, complications and time to mobility were proposed as mechanisms for the association between cognition and functional outcome. Conclusion we identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - L Williamson
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - J Alexander
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Filliter
- Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - L M Bearne
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
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Aquilani R, Zuccarelli GC, Condino AM, Catani M, Rutili C, Del Vecchio C, Pisano P, Verri M, Iadarola P, Viglio S, Boschi F. Despite Inflammation, Supplemented Essential Amino Acids May Improve Circulating Levels of Albumin and Haemoglobin in Patients after Hip Fractures. Nutrients 2017. [PMID: 28635634 PMCID: PMC5490616 DOI: 10.3390/nu9060637] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Essential amino acids (EAAs) are nutritional substrates that promote body protein synthesis; thus we hypothesised that their supplementation may improve circulating albumin (Alb) and haemoglobin (Hb) in rehabilitative elderly patients following hip fractures (HF). Out of the 145 HF patients originally enrolled in our study, 112 completed the protocol. These subjects were divided into two randomised groups, each containing 56 patients. For a period of two months, one group (age 81.4 ± 8.1 years; male/female 27/29) received a placebo, and the other (age 83.1 ± 7.5 years; male/female 25/31) received 4 + 4 g/day oral EAAs. At admission, the prevalence of both hypoAlb (<3.5 g/dL) and hypoHb (<13 g/dL male, <12 g/dL female) was similar in the placebo group (64.3% hypoAlb, 66% hypoHb) and the treated group of patients (73.2% hypoAlb, 67.8% hypoHb). At discharge, however, the prevalence of hypoAlb had reduced more in EAAs than in placebo subjects (31.7% in EAAs vs. 77.8% in placebo; p < 0.001). There was a 34.2% reduction of anaemia in hypoHb in EAA subjects and 18.9% in placebo subjects, but the difference was not statistically significant. Oral supplementation of EAAs improves hypoAlb and, to a lesser extent, Hb in elderly rehabilitative subjects with hip fractures. Anaemia was reduced in more than one third of patients, which, despite not being statistically significant, may be clinically relevant.
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Affiliation(s)
- Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Ginetto Carlo Zuccarelli
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14. I-27100 Pavia, Italy.
| | - Michele Catani
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Carla Rutili
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Consiglia Del Vecchio
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Pietro Pisano
- Istituto Geriatrico P. Redaelli -Reparti di Riabilitazione Geriatrica e di Mantenimento, Via Leopardi, 3. I-20090 Vimodrone, Milano, Italy.
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Paolo Iadarola
- Dipartimento di Biologia e Biotecnologie Università degli Studi di Pavia, Via Ferrata, 1. I-27100 Pavia, Italy.
| | - Simona Viglio
- Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Viale Taramelli, 3/B. I-27100 Pavia, Italy.
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Viale Taramelli, 14. I-27100 Pavia, Italy.
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Enrichissement alimentaire après fracture ostéoporotique au cours d’une réhabilitation en soins de suite et réadaptation orthogériatrique : intérêt nutritionnel et/ou fonctionnel ? NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Röhrig G, Becker I, Polidori MC, Schulz RJ, Noreik M. Association of anemia and hypoalbuminemia in German geriatric inpatients: Relationship to nutritional status and comprehensive geriatric assessment. Z Gerontol Geriatr 2015; 48:619-24. [PMID: 25877770 DOI: 10.1007/s00391-015-0872-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anemia and hypoalbuminemia (HA) are acknowledged independent risk factors for morbidity and mortality in geriatric patients and are associated with nutritional status and frailty. Data exist regarding the association between albumin and frailty, anemia and frailty as well as frailty and nutritional status; however, there is a lack of information on the association between HA, anemia and nutritional status in older people. PATIENTS AND METHODS This study retrospectively analyzed 626 patients admitted to a German geriatrics department (average age 81.1 years, 68.2% female and 31.8% male) for anemia and HA. Data from the comprehensive geriatric assessment (CGA) and from the mini-nutritional assessment (MNA) were available in all patients. RESULTS Patients with anemia suffered significantly more often from HA (p<0.001) than patients without anemia, with an odds ratio (OR) of 1.99 (95% confidence interval CI: 1.2-3.2) and of 5.41 (CI 95%: 2.3-12.6) in patients at risk for malnutrition and in malnourished patients, respectively. A moderately significant association was seen between hemoglobin (Hb) and albumin values (Pearson's correlation r=0.330; p<0.001) as well as between albumin values and the Barthel index (Spearman's correlation r=0.210; p<0.001). CONCLUSION Anemia appears to be a risk factor for HA in inpatients with malnutrition and the observed association between albumin and Hb warrants further research. Geriatric inpatients with anemia should be evaluated in terms of the presence of malnutrition risk and HA.
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Affiliation(s)
- G Röhrig
- University of Cologne, Medical Faculty and St. Marien-Hospital, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - I Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - M C Polidori
- University of Cologne, Medical Faculty, Cologne, Germany
| | - R-J Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany
| | - M Noreik
- Department of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany
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Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marín-Ciancas F, Malafarina V. Serum albumin and health in older people: Review and meta analysis. Maturitas 2015; 81:17-27. [PMID: 25782627 DOI: 10.1016/j.maturitas.2015.02.009] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 12/23/2022]
Abstract
Albumin is the most abundant plasmatic protein. It is only produced by the liver and the full extent of its metabolic functions is not known in detail. One of the main roles assigned to albumin is as an indicator of malnutrition. There are many factors, in addition to nutrition, that influence levels of albumin in plasma. The main aim of this review is to assess the clinical significance of albumin in elderly people in the community, in hospital and in care homes. Following the review, it can be stated that age is not a cause of hypoalbuminemia. Albumin is a good marker of nutritional status in clinically stable people. Significant loss of muscle mass has been observed in elderly people with low albumin levels. Hypoalbuminemia is a mortality prognostic factor in elderly people, whether they live in the community or they are in hospital or institutionalized. Low levels of albumin are associated to worse recovery following acute pathologies. Inflammatory state and, particularly, high concentrations of IL-6 and TNF-alpha, are two of the main influencing factors of hypoalbuminemia. In elderly patients with a hip fracture, albumin levels below 38 g/L are associated to a higher risk of post-surgery complications, especially infections. Further research is needed on the impact of nutritional intervention upon albumin levels and on the outcomes in elderly people in the community, in hospital and in care.
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Affiliation(s)
- Sonia Cabrerizo
- Nutrition Service, Clinica Los Manzanos, Grupo Viamed, Calle Hermanos Maristas, 26140 Lardero, Spain
| | - Daniel Cuadras
- Servei d'Assessorament Metodològic i Estadístic a la RecercaUnitat de Recerca i Desenvolupament, Parc Sanitari Sant Joan de Déu - Fundació Sant Joan de Déu, Dr. Antoni Pujades 42, 08830 Sant Boi de Llobregat (Barcelona), Spain
| | - Fernando Gomez-Busto
- Geriatric Department, Residencia San Prudencia, Calle Francia 35, 01002 Vitoria-Gasteiz, Spain
| | - Iñaki Artaza-Artabe
- Geriatric Department, Orue Centro Socio Sanitario, Grupo Igurco, B° San Miguel Dudea s/n, 48340 Amorebieta, Spain
| | - Fernando Marín-Ciancas
- Geriatric Department, Clinica Los Manzanos, Grupo Viamed, Calle Hermanos Maristas, 26140 Lardero, Spain
| | - Vincenzo Malafarina
- Geriatric Department, Clinica Los Manzanos, Grupo Viamed, Calle Hermanos Maristas, 26140 Lardero, Spain.
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Yoshihara A, Iwasaki M, Ogawa H, Miyazaki H. Serum albumin levels and 10-year tooth loss in a 70-year-old population. J Oral Rehabil 2013; 40:678-85. [PMID: 23855646 DOI: 10.1111/joor.12083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 12/15/2022]
Abstract
Serum albumin levels are a practical marker of general health status in the elderly and have been used to determine the severity of underlying diseases and the risk for death. This longitudinal study evaluated the relationship between serum albumin concentrations and tooth loss over 10 years in elderly subjects, after controlling for confounding factors. A sample of 554 dentate subjects among enrolled subjects (n = 600) was involved in this planned longitudinal study with follow-up examinations after 5 and 10 years. At the 5-year follow-up, 373 (67·3%), subjects were available for re-examination. In addition, 331 (59·7%) were available at the 10-year follow-up. Multiple Poisson regression analysis was conducted to evaluate the relationship between the number of missing teeth over 5 or 10 years and serum albumin levels at baseline after adjusting for 10 variables: gender, serum markers levels at baseline, dental status, smoking habits and educational years and oral health behaviour. The number of missing teeth over 5 or 10 years was significantly negatively associated with serum albumin levels at baseline [incidence rate ratios (IRR) = 0·373, P < 0·0001 for 5 years; IRR = 0·570, P < 0·0001 for 10 years]. We conclude that elderly subjects with hypoalbuminemia are at high risk for 5- and 10-year tooth loss.
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Affiliation(s)
- A Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
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Morley MA, Coots LA, Forgues AL, Gage BJ. Inpatient Rehabilitation Utilization for Medicare Beneficiaries With Multiple Sclerosis. Arch Phys Med Rehabil 2012; 93:1377-83. [DOI: 10.1016/j.apmr.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/04/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022]
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Justo D, Vislapu N, Shvedov V, Fickte M, Danylesko A, Kimelman P, Merdler C, Lerman Y. Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients following hip arthroplasty. Arch Gerontol Geriatr 2011; 53:e33-6. [DOI: 10.1016/j.archger.2010.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/28/2010] [Accepted: 10/04/2010] [Indexed: 11/30/2022]
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Luk JKH, Chiu PKC, Tam S, Chu LW. Relationship between admission albumin levels and rehabilitation outcomes in older patients. Arch Gerontol Geriatr 2010; 53:84-9. [PMID: 20678814 DOI: 10.1016/j.archger.2010.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
The relationship between serum albumin level and rehabilitation outcome in older patients has not been fully explored. This study investigated this association in older Chinese patients. We studied 1604 patients in two geriatric convalescence hospitals. Admission albumin levels (g/l) were measured and segregated into three groups: <30 g/l; 30 to <35 g/l; ≥35 g/l. Absolute functional and motor gain were determined by Barthel index (BI) and elderly mobility scale (EMS) and expressed as BI efficacy and EMS efficacy. BI and EMS efficiency were deduced by the efficacy divided by the length of hospital stay (LOS). Satisfactory motor and functional outcomes were defined as discharge EMS≥15 and BI≥75. Significant improvement in EMS and BI scores across all 3 albumin groups on discharge was observed, with lower scores in low albumin groups. The EMS and BI efficacy were the same in 3 albumin groups. However, EMS and BI efficiency were higher in the high albumin groups. Admission albumin was not independent predictors for satisfactory motor and functional outcomes. For satisfactory motor outcome (EMS≥15), female gender (p=0.0004), age (p=0.0009) and urinary incontinence (p=0.0076) were negative predictors while living at home (p=0.0028), admission EMS (p<0.001) and BI score (p=0.0004) were positive predictors. For satisfactory functional outcome (BI≥75), age (p=0.015) and urinary incontinence (p<0.001) were negative predictors while female gender (p=0.0024), LOS (p=0.033), C-MMSE (p<0.001), admission EMS (p=0.003) and BI (p<0.001) were positive predictors. Admission albumin levels were related to functional and motor efficiency, but not with absolute functional and motor gain. Albumin was not an independent predictor for satisfactory motor and functional outcome.
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Affiliation(s)
- James Ka Hay Luk
- The University of Hong Kong, Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Room 801 Administrative Block, Pokfulam Road, Hong Kong, SAR, China.
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Fisher A, Goh S, Srikusalanukul W, Davis M. Elevated serum PTH is independently associated with poor outcomes in older patients with hip fracture and vitamin D inadequacy. Calcif Tissue Int 2009; 85:301-9. [PMID: 19763373 DOI: 10.1007/s00223-009-9283-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/12/2009] [Indexed: 02/03/2023]
Abstract
To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D < 80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D < 50 nmol/l) was 79.8%, and that of elevated PTH level (>6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P < 0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOS > or = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOS > or = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOS > or = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.
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Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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O'Daly BJ, Walsh JC, Quinlan JF, Falk GA, Stapleton R, Quinlan WR, O'Rourke SK. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr 2009; 29:89-93. [PMID: 19674819 DOI: 10.1016/j.clnu.2009.07.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 06/27/2009] [Accepted: 07/20/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Hip fractures are a significant cause of mortality and morbidity in the elderly. Malnutrition is a significant contributor to this, however no consensus exists as to the detection or management of this condition. We hypothesise that results of admission serum albumin and total lymphocyte count (TLC), as markers of Protein Energy Malnutrition (PEM) can help predict clinical outcome in hip fracture patients aged over 60 years. METHODS This retrospective study evaluated the nutritional status of patients with hip fractures using albumin and TLC assays and analysed their prognostic relevance. Clinical outcome parameters studied were delay to operation, duration of in-patient stay, re-admission and in-patient, 3- and 12-month mortality. RESULTS Four hundred and fifteen hip fracture patients were evaluated. Survival data were available for 377 patients at 12 months. In-hospital mortality for PEM patients was 9.8%, compared with 0% for patients without. Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters (Odds Ratio 4.6; 95% CI: 1.0-21.3). Serum albumin (Hazard Ratio 0.932, 95% CI: 0.9-1.0) and age (Hazard Ratio 1.04, 95% CI: 1.0-1.1) were found to be significant independent prognostic factors of mortality by Cox regression analysis. CONCLUSIONS These results highlight the relevance of assessing the nutritional status of patients with hip fractures at the time of admission and emphasises the correlation between PEM and outcome in these patients.
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Affiliation(s)
- Brendan J O'Daly
- Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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