Investigation Of The Relationship Between Prognostic Nutrition Index And Mortality In Patients With Femur Fracture

Abstract

Aim: The incidence of adverse postoperative outcomes in surgeries for femur fractures is high and is associated with malnutrition. In this study, it was aimed to determine the independent factors for 6-month survival in patients with femur fracture and to evaluate the predictive value of the prognostic nutrition index (PNI). Material and Method: One hundred and sixteen patients operated on only for femoral fracture were divided into survival and non-survival groups according to mortality.Demographic characteristics of the patients, operation data, fracture sites, need for intensive care unit and length of stay, postoperative hospital stay, and preoperative laboratory values, prognostic nutrition indices and mortality were evaluated. Results: Twenty-six (22.4%) of 116 patients who were operated for femoral fracture resulted in 6-month mortality. CRP, albumin, prealbumin, crp/albumin ratio and PNI values at admission were independent risk factors for postoperative mortality (p=0.014, p<0.001, p=0.041, p=0.003, p<0.001). The optimal cut-off value for PNI was determined as 29.0. In the group with PNI>29.0, survival rates were found to be higher at the end of the 1st, 3rd and 6th months (94.2%, 89.5%, 89.5%). Conclusion: Nutritional indices should be evaluated when patients with femoral fractures are admitted to the hospital. A low prognostic nutritional index may a predict mortality in patients with femoral fractures.

Keywords

• prognostic nutrition index
• femur fracture
• mortality

Femur Kırığı Olan Hastalarda Prognostik Nutrisyon İndeksi İle Mortalite Arasındaki İlişkinin Araştırılması

Abstract

Amaç: Femur kırıkları için yapılan ameliyatlarda postoperatif olumsuz sonuçların insidansı yüksektir ve yetersiz beslenme ile ilişkilidir. Bu çalışmada femur kırığı olan hastalarda 6 aylık sağkalım için bağımsız faktörlerin belirlenmesi ve prognostik beslenme indeksinin (PNI) prediktif değerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Sadece femur kırığı nedeniyle opere edilen 116 hasta mortaliteye göre hayatta kalan ve hayatta kalmayan gruplara ayrıldı. Hastaların demografik özellikleri, operasyon verileri, kırık bölgeleri, yoğun bakım ihtiyacı ve kalış süresi, postoperatif hastanede kalış süresi, preoperatif laboratuvar değerleri, prognostik beslenme indeksleri ve mortalite değerlendirildi. Bulgular: Femur kırığı nedeniyle opere edilen 116 hastanın 26'sı (%22.4) 6 aylık mortalite ile sonuçlandı. CRP, albumin, prealbumin, crp/albumin oranı ve PNI değerleri postoperatif mortalite için bağımsız risk faktörleriydi (p=0.014, p<0.001, p=0.041, p=0.003, p<0.001). PNI için optimal cut-off değeri 29,0 olarak belirlendi. PNI>29.0 olan grupta 1., 3. ve 6. ay sonunda sağkalım oranları daha yüksek bulundu (%94.2, %89.5, %89.5). Sonuç: Femur kırığı olan hastalar hastaneye kabul edildiğinde beslenme indeksleri değerlendirilmelidir. Düşük bir prognostik beslenme indeksi, femur kırığı olan hastalarda mortaliteyi öngörebilir.

Keywords

• prognostik nutrisyon indeksi
• femur fraktürü
• mortalite

References

1. 1. Melton LJ 3rd. Hip fractures: a worldwide problem today and tomorrow. Bone. 1993;14 Suppl 1:S1-8.
2. 2. Hughes MS, Kazmier P, Burd TA, Anglen J, Stoker AM, Kuroki Ket al. Enhanced fracture and soft-tissue healing by means of anabolic dietary supplementation. J Bone Joint Surg Am. 2006 Nov;88(11):2386-94. 3. Amarilla-Donoso FJ, López-Espuela F, Roncero-Martín R, Leal-Hernandez O, Puerto-Parejo LM, Aliaga-Vera I, et al. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes. 2020 Mar 14;18(1):71.
3. 4. Giancola R, Marchesi LP, Lettera MG, Antonini G. A complex proximal femoral fracture. Injury. 2016 Oct;47 Suppl 4:S121-S123.
4. 5. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002 May 18;359(9319):1761-7.
5. 6. Meesters DM, Wijnands KAP, Brink PRG, Poeze M. Malnutrition and Fracture Healing: Are Specific Deficiencies in Amino Acids Important in Nonunion Development? Nutrients. 2018; 10(11):1597.
6. 7. Phan K, Ranson W, White SJ, et al. ThirtyDay Perioperative Complications, Prolonged Length of Stay, and Readmission Following Elective Posterior Lumbar Fusion Associated With Poor Nutritional Status. Global Spine J. 2019;9(4):417-23.
7. 8. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415-21.
8. 9. Williams DG, Wischmeyer PE. Perioperative Nutrition Care of Orthopedic Surgery Patient. Tech Orthop. 2020;35(1):15-8.

9. 10. Caputo F, Dadduzio V, Tovoli F, et al. The role of PNI to predict survival in advanced hepatocellular carcinoma treated with Sorafenib. PLoS Bir. 2020;15(5):e0232449.
10. 11. Cadwell JB, Afonso AM, Shahrokni A. Prognostic nutritional index (PNI), independent of frailty is associated with six-month postoperative mortality. J Geriatr Oncol. 2020 Jun;11(5):880-884.
11. 12. Li X, Chen J. Is the prognostic nutritional index (PNI) a useful predictive marker for postoperative complications after lung surgery? J Thorac Dis. 2019 Mar;11(Suppl 3):S334-S336.
12. 13. Hill GL, Witney GB, Christie PM, Church JM. Protein status and metabolic expenditur determine the response to intravenous nutrition-a new classification of surgical malnutrition. Br J Surg 1991;78:109-113.
13. 14. Meakins JL, Christou NV, Shizgal HM, MacLean LD. Therapeutic approaches to anergy in surgical patients. Surgery and levamisole. Ann Surg 1979;190:286-296.
14. 15. Morey VM, Song YD, Whang JS, Kang YG, Kim TK. Can serum albumin level and total lymphocyte count be surrogates for malnutrition to predict wound complications after total knee arthroplasty? J. Arthroplasty. 2016;31(6):1317–21.
15. 16. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160–7.
16. 17. Özbek M, Acun B, Arık B, Demir M, Oylumlu M, Toprak N. "Prognostic value of nutritional and inflammatory scores in Transcatheter aortic valve replacement patients." Dicle Med J (2022) 49 (3) : 422-429
17. 18. Bistrian BR, Blackburn GL, Hallowell E, Heddle R. Protein status of general surgical patients. JAMA 1974;230:858-60
18. 19. Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999;13:164-9.
19. 20. .Pioli G, Barone A, Giusti A, et al. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 2006;18:381-7
20. 21. Gianotti L, Braga M, Fortis C, et al. A prospective, randomized clinical trial on perioperative feeding with an arginine-, omega-3 fatty acid-, and RNAenriched enteral diet: effect on host response and nutritional status. J Parenter Enteral Nutr 1999;23:314-20.
21. 22. Ansar W, Ghosh S. Inflammation and inflammatory diseases, markers, and media-tors: Role of CRP in some inflammatory diseases. In: Biology of C Reactive Pro-tein in Health and Disease. Berlin, Germany: Springer; 2016. p. 67–107
22. 23. Li JJ, Fang CH. C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses 2004;62:499–506.
23. 24. Beloosesky Y, Hendel D, Weiss A, et al. Cytokines and C-reactive protein production in hip-fracture-operated elderly pa-tients. J Gerontol Ser Biol Sci Med Sci 2007;62:420–6.
24. 25. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. Creactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013;8(3):e59321.
25. 26. Wu M, Guo J, Guo L, Zuo Q. The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer. Tumor Biol. 2016;37(9):12525–12533.
26. 27. Peng J, Wu G, Chen J, Chen H. Preoperative C-reactive protein/albumin ratio, a rrisk factor for postoperative delirium in elderly patients after total joint arthroplasty. J Arthroplasty. 2019;34(11): 2601–2605.
27. 28. Capkin, Sercan, Serkan Guler, and Ramadan Ozmanevra. "C-reactive protein to albumin ratio may predict mortality for elderly population who undergo hemiarthroplasty due to hip fracture." Journal of Investigative Surgery 34.11 (2021): 1272-1277.