Nutritional status as independent prognostic factor of outcome and mortality until five years after hip fracture: a comprehensive prospective study

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Summary
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.

Purpose
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.

Methods
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.

Results
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.

Conclusion
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.
OriginalsprogEngelsk
TidsskriftOsteoporosis International
Vol/bind35
Udgave nummer7
Sider (fra-til)1273-1287
ISSN0937-941X
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
Open access funding provided by National Hospital The Netherlands Organization for Health Research and Development (ZonMw, Grant/Award Number: 80\u2013007022\u201398-07510 / 94507510) financed the original RCT, which prior to starting enrolment was registered at http://www.clinicaltrials.gov as NCT00523575. Design and results of the RCT were previously published [, ]. The funding organization did not have any influence on study design or on data collection, analysis or interpretation, nor on the decision to submit the present paper for publication.

Publisher Copyright:
© The Author(s) 2024.

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