Fri., 10/17/08 Geriatrics/Reconstruction, Paper #38, 4:18 pm OTA-2008
Are Serum Albumin and Total Lymphocyte Count Accurate Predictors of Outcome in Hip Fractures?
Brendan J. O’Daly, MD1 (n); James C. Walsh, MD1 (n); John F. Quinlan, MD1 (n);
Robert Stapleton, PhD2 (n); William R. Quinlan, MD1 (n); Kieran O’Rourke, MD1 (n);
1Department of Orthopaedic Surgery, St. Vincent’s University Hospital, Dublin, Ireland;
2Department of Statistics, National University of Ireland, Maynooth, Ireland
Purpose: Protein energy malnutrition (PEM) is an accepted predictor of poor outcome in hip fracture patients. There is no universally accepted definition of PEM. Screening for PEM is not routinely performed in hip fracture patients. Reported incidence in elderly hip fracture patients varies widely, between 9.0% and 88.6%. Our objective was to determine if admission serum albumin and total lymphocyte count (TLC), as clinical markers of PEM, are accurate predictors of outcome for hip fracture patients.
Methods: In this retrospective review of 411 patients with operatively managed hip fracture, PEM was defined as albumin <3.5 g/dL and TLC <1500 cells/mm3. Delay to operation; duration of inpatient stay; re-admission (<3 months); and inpatient, 3-month, and 12-month mortality were assessed as outcome variables.
Results: Survival data were available for 377 patients at 12 months. Of 377 patients, 53% (n = 200) had both a serum albumin and TLC levels taken at admission (study), while 47% (n = 177) had not (control). Incidence of PEM was 51%. Older patients were more likely to have lower albumin (P = 0.017) and TLC (P = 0.023). Nursing home patients were also more likely to have lower albumin (P = 0.033). In-hospital mortality for PEM patients was 9.8%, compared with 0% for patients with normal values of both laboratory parameters. Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters (odds ratio = 4.6; P = 0.049).
Conclusion: Serum albumin and TLC in combination are accurate predictors of 12-month mortality in hip fracture patients. These results highlight the relevance of assessing the nutritional status of patients with hip fractures at the time of admission and emphasizes the relationship between nutrition and outcome in these patients.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.