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Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis

Background: Hip fractures are becoming a growing concern due to an aging population. The high costs to the healthcare system and far-reaching consequences for those affected, including a loss of independence and increased mortality rates, make this issue important. Poor nutritional status is a commo...

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Autores principales: Popp, Domenik, Nia, Arastoo, Biedermann, Gregor, Schmoelz, Lukas, Silvaieh, Sara, Tiefenboeck, Thomas M., Hajdu, Stefan, Widhalm, Harald K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420813/
https://www.ncbi.nlm.nih.gov/pubmed/37571292
http://dx.doi.org/10.3390/nu15153357
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author Popp, Domenik
Nia, Arastoo
Biedermann, Gregor
Schmoelz, Lukas
Silvaieh, Sara
Tiefenboeck, Thomas M.
Hajdu, Stefan
Widhalm, Harald K.
author_facet Popp, Domenik
Nia, Arastoo
Biedermann, Gregor
Schmoelz, Lukas
Silvaieh, Sara
Tiefenboeck, Thomas M.
Hajdu, Stefan
Widhalm, Harald K.
author_sort Popp, Domenik
collection PubMed
description Background: Hip fractures are becoming a growing concern due to an aging population. The high costs to the healthcare system and far-reaching consequences for those affected, including a loss of independence and increased mortality rates, make this issue important. Poor nutritional status is a common problem among geriatric patients and is associated with a worse prognosis. Nutritional screening tools can help identify high-risk patients and enable individualized care to improve survival rates. Material and methods: This retrospective study investigates four nutritional scores and laboratory parameters’ predictive significance concerning postoperative mortality after surgical treatment of proximal femur fractures at 1, 3, 6, and 12 month/s for patients over 60 years using the chi-square test, Cox regression analysis, and receiver operating characteristics (ROC). The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines were used as part of the screening of the respective nutritional status of the patients, in particular to filter out malnutrition. Results: A total of 1080 patients were included in this study, whereas 8.05% suffered from malnutrition, defined as a body mass index (BMI) below 18.5 kg/m(2). The Mini Nutritional Assessment (MNA) screening tool identified the highest proportion of malnourished patients at 14.54%. A total of 36.39% of patients were at risk of malnutrition according to three nutrition scores, with MNA providing the most significant proportion at 41.20%. Patients identified as malnourished had a higher mortality rate, and MNA screening was the only tool to show a significant correlation with postoperative mortality in all survey intervals. The MNA presented the best predictive significance among the screening tools, with a maximum area under the curve (AUC) of 0.7 at 12 month postoperatively. Conclusions: MNA screening has a solid correlation and predictive significance regarding postoperative mortality—therefore routine implementation of this screening in orthopedic/traumatology wards is recommended. Moreover, nutritional substitution therapy can offer a relatively inexpensive and easy-to-implement measure. The Graz malnutrition screening (GMS) shows moderate predictive power and could be considered as an alternative for patients under 60 years of age. A higher albumin level is associated with improved survival probability, but cannot be indicative of nutritional status.
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spelling pubmed-104208132023-08-12 Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis Popp, Domenik Nia, Arastoo Biedermann, Gregor Schmoelz, Lukas Silvaieh, Sara Tiefenboeck, Thomas M. Hajdu, Stefan Widhalm, Harald K. Nutrients Article Background: Hip fractures are becoming a growing concern due to an aging population. The high costs to the healthcare system and far-reaching consequences for those affected, including a loss of independence and increased mortality rates, make this issue important. Poor nutritional status is a common problem among geriatric patients and is associated with a worse prognosis. Nutritional screening tools can help identify high-risk patients and enable individualized care to improve survival rates. Material and methods: This retrospective study investigates four nutritional scores and laboratory parameters’ predictive significance concerning postoperative mortality after surgical treatment of proximal femur fractures at 1, 3, 6, and 12 month/s for patients over 60 years using the chi-square test, Cox regression analysis, and receiver operating characteristics (ROC). The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines were used as part of the screening of the respective nutritional status of the patients, in particular to filter out malnutrition. Results: A total of 1080 patients were included in this study, whereas 8.05% suffered from malnutrition, defined as a body mass index (BMI) below 18.5 kg/m(2). The Mini Nutritional Assessment (MNA) screening tool identified the highest proportion of malnourished patients at 14.54%. A total of 36.39% of patients were at risk of malnutrition according to three nutrition scores, with MNA providing the most significant proportion at 41.20%. Patients identified as malnourished had a higher mortality rate, and MNA screening was the only tool to show a significant correlation with postoperative mortality in all survey intervals. The MNA presented the best predictive significance among the screening tools, with a maximum area under the curve (AUC) of 0.7 at 12 month postoperatively. Conclusions: MNA screening has a solid correlation and predictive significance regarding postoperative mortality—therefore routine implementation of this screening in orthopedic/traumatology wards is recommended. Moreover, nutritional substitution therapy can offer a relatively inexpensive and easy-to-implement measure. The Graz malnutrition screening (GMS) shows moderate predictive power and could be considered as an alternative for patients under 60 years of age. A higher albumin level is associated with improved survival probability, but cannot be indicative of nutritional status. MDPI 2023-07-28 /pmc/articles/PMC10420813/ /pubmed/37571292 http://dx.doi.org/10.3390/nu15153357 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Popp, Domenik
Nia, Arastoo
Biedermann, Gregor
Schmoelz, Lukas
Silvaieh, Sara
Tiefenboeck, Thomas M.
Hajdu, Stefan
Widhalm, Harald K.
Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis
title Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis
title_full Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis
title_fullStr Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis
title_full_unstemmed Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis
title_short Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores—A Retrospective Data Analysis
title_sort predictive validity of mortality after surgically treated proximal femur fractures based on four nutrition scores—a retrospective data analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420813/
https://www.ncbi.nlm.nih.gov/pubmed/37571292
http://dx.doi.org/10.3390/nu15153357
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