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Serum albumin, total lymphocyte count predict mortality in hip fracture patients
Of the 200 patients tested for these two laboratory parameters, 51% had protein energy malnutrition.
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DENVER — Although protein energy malnutrition predicts poor outcome in hip fracture patients, an accepted definition of the condition remains elusive.
Now research reveals that serum albumin and total lymphocyte count (TLC) in combination can be used as a surrogate marker for the condition, and accurately predict mortality at 1 year post-hip fracture.
Using a serum albumin level less than 3.5 g/dL and a TLC less than 1,500 cells/mm3 to define protein energy malnutrition (PEM), Brendan J. O’Daly, MD, and colleagues from Dublin retrospectively reviewed the 12-month survival data of 200 patients who had both laboratory parameters measured at admission for hip fracture surgery, and 177 patients who did not undergo the testing prior to hip fracture surgery.
To determine the prognostic relevance of the two laboratory parameters as markers of PEM and to assess whether they could predict outcomes, the investigators studied the following outcome variables:
- delayed operation;
- duration of in-patient stay;
- readmission in less than 3 months after operation;
- inpatient mortality;
- 3-month mortality rates; and
- 6-month mortality rates.
The investigators discovered a 51% incidence of protein energy malnutrition. In addition, they found a 9.8% in-hospital mortality rate for patients who had protein energy malnutrition compared to a 0% rate for patients with normal serum albumin and TLC values.
“Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters,” O’Daly said during his presentation at the 24th Annual Meeting of the Orthopaedic Trauma Association. “It remained significant after correction for age, domicile [status] and gender by multivariate statistic regression analysis.”
The research also showed that patients with PEM were more likely to live in a nursing home and be slightly older.
“The key conclusion [is] that serum albumin and TLC in combination are accurate predictors of 12-month mortality for hip fracture patients,” O’Daly said. “The study underscores the clinical 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 this patient cohort.”
For more information:
- Brendan J. O’Daly, MD, can be reached at St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; +353-1-221-4000; e-mail: brendan.odaly@ucd.ie. He has no direct financial interest in any products or companies mentioned in this article.
Reference:
- O’Daly BJ, Walsh JC, Quinlan JF, et al. Are serum albumin and total lymphocyte count accurate predictors of outcome in hip fractures? Paper #38. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.