Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study

ABSTRACT Background Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. Objective This study aims to determine whether 25-hydroxyvitamin D [25(OH)D] concentration or the Geriatric Nutritional Risk Index (GNRI) is associated with mortality or rates of walking in a patient cohort after hip fracture surgery. Methods Patients undergoing hip fracture repair from a multisite study in North America were included. Mortality and mobility were assessed at 30 and 60 d after surgery. Serum albumin, 25(OH)D, and intact parathyroid hormone were measured. Patients were characterized according to 25(OH)D <12 ng/mL, 12 to <20 ng/mL, 20 to <30 ng/mL, or ≥30 ng/mL. GNRI was categorized into major/moderate nutritional risk (<92), some risk (92 to <98), or in good nutritional status (≥98). Results Of the 290 patients [aged 82 ± 7 y, BMI (kg/m2): 25 ± 5], 73% were women. Compared with patients with <12 ng/mL, those with higher 25(OH)D concentrations had higher rates of walking at 30 d (P = 0.031): 12 to <20 ng/mL (adjusted OR: 2.61; 95% CI: 1.13, 5.99); 20 to <30 ng/mL (3.48; 1.53, 7.95); ≥30 ng/mL (2.84; 1.12, 7.20). In addition, there was also greater mobility at 60 d (P = 0.028) in patients with higher 25(OH)D compared with the reference group (<12 ng/mL). Poor nutritional status (GNRI <92) showed an overall trend to reduce mobility (unadjusted P = 0.044 and adjusted P = 0.056) at 30 but not at 60 d. There was no association of vitamin D or GNRI with mortality at either time. Conclusions Vitamin D deficiency (<12 ng/mL) is associated with reduced ambulation after hip fracture surgery, whereas GNRI also contributes to immobility but is a less reliable predictor. Mechanisms that can explain why vitamin D deficiency is associated with mobility should be addressed in future studies.

Download Full-text

Vitamin D Levels and Nutritional Risk Index: Mobility and Mortality After Hip Fracture Surgery (P01-013-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-013-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Lihong Hao ◽

Yvette Schlussel ◽

Jeffrey Carson ◽

Sue Shapses

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Vitamin D Deficiency ◽

Risk Index ◽

Nutritional Risk ◽

Walking Ability ◽

Hip Fracture Surgery ◽

Vitamin D Levels ◽

Nutritional Risk Index ◽

Fracture Surgery

Abstract Objectives Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. This study aims to determine whether 25-hydroxyvitamin D (25(OH)D) or the Geriatric Nutritional Risk Index (GNRI) is associated with short term mortality or ability to walk after hip fracture surgery. Methods Patients undergoing hip fracture repair were included in this study. Mortality and walking ability were assessed at 30 and 60 days after hip fracture surgery. Pre-operative serum albumin and 25(OH)D were measured. Patients were characterized with 25(OH)D <12 ng/mL, 12 to <20, 20 to <30 or ≥30. GNRI was calculated from albumin and body weight and patients were categorized into major/moderate nutritional risk (<92), low risk (92 to <98) or in good nutritional status (≥98). Results Of the 290 patients (82 ± 7 years, BMI 25 ± 5 kg/m2), 73% were females. Compared to patients with vitamin D deficiency (<12 ng/mL), those with vitamin D levels in higher categories had increased ability to walk at 30 days (P = 0.031): 12 to <20 ng/ml (adjusted odds ratio = 2.61; 95% confidence interval = 1.13–5.99); 20 to <30 ng/ml (3.48; 1.53–7.95); ≥30 ng/ml (2.84; 1.12–7.20). In addition, patients also had increased mobility at 60 days in these same higher vitamin D categories 12 to <20 (2.67; 1.14–6.25); 20 to <30 (3.42; 1.46–8.00); ≥30 ng/ml (3.67; 1.37–9.82) compared to the reference group (<12 ng/mL; P = 0.028). There was no association of vitamin D with mortality at either time point. GNRI was not associated with mortality or walking ability. Conclusions In patients with hip fracture, vitamin D deficiency (<12 ng/mL) was associated with reduced ambulation after surgery, whereas GNRI was not associated with any outcomes. Mechanisms that attenuate mobility due to vitamin D deficiency should be examined in future studies. Funding Sources ONE Nutrition Grant to SAS and JLC.

Download Full-text

Geriatric Nutritional Risk Index and Controlling Nutritional Status Score can predict postoperative 180-day mortality in hip fracture surgeries

JA Clinical Reports ◽

10.1186/s40981-019-0282-6 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 2

Author(s):

Atsushi Kotera

Keyword(s):

Hip Fracture ◽

Nutritional Status ◽

Serum Albumin ◽

Serum Albumin Level ◽

Risk Index ◽

Albumin Level ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Status Score ◽

Nutritional Risk Index

Abstract Background The Geriatric Nutritional Risk Index (GNRI) based on serum albumin level and body weight and the Controlling Nutritional Status Score (CONUT) based on serum albumin level, total cholesterol level, and total lymphocyte count were created to evaluate objectively a patient’s nutritional status in 2005. Here we validated the usefulness of the GNRI and the CONUT as a prognostic factor of the 180-day mortality in patients who underwent hip fracture surgeries. We retrospectively collected data from patients with hip surgeries performed from January 2012 to December 2018. The variables required for the GNRI and the CONUT and the factors presumably associated with postoperative mortality including the patients’ characteristics were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity in category variables. The Mann-Whitney U test was used to test for differences in continuous variables. We validated the power of the GNRI and the CONUT values to distinguish patients who died ≤ 180 days post-surgery from those who did not, by calculating the area under the receiver operating characteristic curve (AUC). The correlation between these two models was analyzed by Spearman’s rank correlation (ρ). Results We retrospectively examined the cases of 607 patients aged 87 ± 6 (range 70–102) years old. The 180-day mortality rate was 5.4% (n = 33 non-survivors). The GNRI value in the non-survivors was 83 ± 9 (range 66–111), which was significantly lower than that in the survivors at 92 ± 9 (range 64–120). The CONUT value in the non-survivors was 6 ± 3 (range 1–11), which was significantly higher than that in the survivors at 4 ± 2 (range 0–11). The AUC value to predict the 180-day mortality was 0.74 for the GNRI and 0.72 for the CONUT. The ρ value between these two models was 0.61 in the total of 607 patients and was 0.78 in the 33 non-survivors. Conclusions Our results suggest that the GNRI and the CONUT are a simple and useful tool to predict the 180-day mortality in patients who have undergone a hip surgery.

Download Full-text

Prognosis in Head and Neck Cancer: Importance of Nutritional and Biological Inflammatory Status

Otolaryngology ◽

10.1177/01945998211004592 ◽

2021 ◽

pp. 019459982110045

Author(s):

Nicolas Saroul ◽

Mathilde Puechmaille ◽

Céline Lambert ◽

Achraf Sayed Hassan ◽

Julian Biau ◽

...

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factors ◽

Inflammatory Response ◽

Nutritional Status ◽

Head And Neck ◽

Neck Cancer ◽

Risk Index ◽

Nutritional Risk ◽

Inflammatory Status ◽

Nutritional Risk Index

Objectives To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer. Study Design Single-center retrospective study of prospectively collected data. Setting Tertiary referral center. Methods Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigestive tract without metastases were assessed at time of diagnosis for several prognostic factors. Nutritional status was assessed by the nutritional risk index, social status by the EPICES score, and inflammatory status by the systemic inflammatory response index. The primary endpoint was overall survival. Results In multivariable analysis, the main prognostic factors were the TNM classification (hazard ratio [HR] = 3.34, P = .002, for stage T3-4), malnutrition as assessed by the nutritional risk index (HR = 3.64, P = .008, for severe malnutrition), and a systemic inflammatory response index score ≥1.6 (HR = 3.32, P = .02). Social deprivation was not a prognostic factor. Conclusion Prognosis in head and neck cancer is multifactorial; however, malnutrition and inflammation are important factors that are potentially reversible by early intervention.

Download Full-text

Abstract 12880: Malnutrition Assessed by Geriatric Nutritional Risk Index Provides the Long-term Prognostic Information in Patients Admitted for Acute Decompensated Heart Failure, Regardless of Reduced or Preserved Left Ventricular Ejection Fraction; A Comparison With Prognostic Nutritional Index and CONUT Score

Circulation ◽

10.1161/circ.132.suppl_3.12880 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

Yusuke Iwasaki ◽

...

Keyword(s):

Nutritional Status ◽

Serum Albumin ◽

Risk Index ◽

Left Ventricular ◽

Nutritional Risk ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Nutritional Index ◽

Nutritional Risk Index ◽

Conut Score

Backgrounds: Malnutrition is associated with increased mortality risk in patients (pts) with acute decompensated heart failure(ADHF). Nutritional status is assessed by several indices, such as Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. However, there is no information available on the comparison of prognostic significance of these indices in ADHF pts, relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 303 consecutive pts admitted for ADHF and discharged alive (HFrEF(LVEF<50%);n=163, HFpEF(LVEF≥50%);n=140). Nutritional status was evaluated at the discharge by GNRI calculated as follows: 14.89 • serum albumin (g/dl) + 41.7 • BMI/22, PNI calculated as follows: 10 • serum albumin (g/dl) + 0.005 • total lymphocyte count (/ml) and CONUT score calculated by serum albumin, total cholesterol levels and lymphocyte count. During a follow-up period of 5.0±4.3 yrs, 75 pts had cardiovascular death (CVD). At multivariate Cox analysis, GNRI (p<0.0001) was significantly associated with CVD, independently of systolic blood pressure, serum sodium level and eGFR, although PNI and CONUT score showed a significant association with CVD at univariate analysis. ROC analysis revealed that GNRI of 88 was a fair discriminator for CVD (AUC 0.70(95%CI 0.63-0.77), p<0.0001). In group with HFrEF, CVD was significantly more frequently observed in pts with than without low GNRI <88 (48% vs 25%, p<0.0001, adjusted HR 3.5[1.8-6.6]). Furthermore, in group with HFpEF, pts with low GNRI had the significantly increased risk, compared to those with high GNRI>88 (36% vs 10%, p<0.0001, adjusted HR 3.8[1.4-10.2]). Conclusion: Malnutrition assessed by Geriatric Nutritional Index provides more valuable long-term prognostic information than PNI and CONUT score in pts admitted for ADHF, regardless of HFrEF or HFpEF.

Download Full-text

Preoperative Nutritional Status and Its Consequences on Abdominal Surgery in Wolaita Zone, Southern Ethiopia: An Institution-Based Observational Study

Journal of Nutrition and Metabolism ◽

10.1155/2020/2324395 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Leila Hussen ◽

Elazar Tadesse ◽

Dereje Yohannes Teferi

Keyword(s):

Wound Healing ◽

Observational Study ◽

Nutritional Status ◽

Abdominal Surgery ◽

Nutritional Assessment ◽

Risk Index ◽

Nutritional Risk ◽

Southern Ethiopia ◽

Increased Risk ◽

Nutritional Risk Index

This study aimed to determine the prevalence of malnutrition and its association with wound healing and length of hospitalization among patients undergoing abdominal surgery admitted to hospitals in the Wolaita zone in southern Ethiopia. Methods. An institution-based prospective observational study was conducted in three hospitals in the Wolaita zone from August to October 2016. All eligible individuals aged between 19 and 55 years were recruited in this study. Anthropometric and biochemical analyses, such as serum albumin (Alb) and total lymphocyte count (TLC), were taken for nutritional assessment during the preoperative period. Quantitative variables were compared using Student’s t test. Cox’s regression was employed to determine which variables were possible risk factors for poor wound healing. Results. A total of 105 patients aged 19 to 55 with a mean age (±SD) of 34 ± 9.6 years were included, and the prevalence of preoperative malnutrition was 27.6%, 87%, according to BMI and nutritional risk index, respectively. Poor wound healing was significantly associated with underweight patients (BMI < 18.5 kg/m2) (AHR: 6.5 : 95%CI: 3.312.9), postoperative weight loss (AHR: 4.9; 95%CI: 2.8–8.5), and nutritional risk index (NRI) less than 97.5 (AHR 1.8; 95% CI: 1.09–3.1). Conclusion. The prevalence of malnutrition is high in our study setup; this is associated with an increased risk of adverse postoperative outcomes. Therefore, our results emphasize the need of routine preoperative nutritional assessment, optimizing nutritional status of patients and postoperative nutritional support.

Download Full-text

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01488-w ◽

2020 ◽

Author(s):

Maximilian Peter Forssten ◽

Ahmad Mohammad Ismail ◽

Gabriel Sjolin ◽

Rebecka Ahl ◽

Per Wretenberg ◽

...

Keyword(s):

Hip Fracture ◽

Operative Mortality ◽

Risk Index ◽

Cardiac Risk ◽

Hip Fracture Surgery ◽

Cardiac Risk Index ◽

Short Term Mortality ◽

Fracture Register ◽

Fracture Surgery ◽

Electronic Hospital

Abstract Purpose The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery. Methods Data was obtained from the national hip fracture register which was cross-referenced with patients’ electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0–1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality. Results A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10–1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21–1.84, p < 0.001). Conclusion The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.

Download Full-text

An initial loading-dose vitamin D versus placebo after hip fracture surgery: baseline characteristics of a randomized controlled trial (REVITAHIP)

BMC Geriatrics ◽

10.1186/1471-2318-14-101 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 7

Author(s):

Jenson CS Mak ◽

Linda A Klein ◽

Terry Finnegan ◽

Rebecca S Mason ◽

Ian D Cameron

Keyword(s):

Vitamin D ◽

Randomized Controlled Trial ◽

Hip Fracture ◽

Controlled Trial ◽

Loading Dose ◽

Hip Fracture Surgery ◽

Randomized Controlled ◽

Initial Loading ◽

Baseline Characteristics ◽

Fracture Surgery

Download Full-text

Evaluation of the volume-value relationship in hip fracture care using evidence-based thresholds

Hip International ◽

10.1177/1120700019837130 ◽

2019 ◽

Vol 30 (3) ◽

pp. 347-353

Author(s):

Sergio M Navarro ◽

William C Frankel ◽

Heather S Haeberle ◽

Damien G Billow ◽

Prem N Ramkumar

Keyword(s):

Hip Fracture ◽

Operating Characteristic ◽

Care Delivery ◽

High Volume ◽

Fracture Repair ◽

Fracture Care ◽

Hip Fracture Surgery ◽

Lower Volume ◽

Relative Market Share ◽

Fracture Surgery

Background: Studies have shown high-volume surgeons and hospitals deliver higher value care. The aims of this study were to establish meaningful thresholds defining high-volume surgeons and hospitals performing hip fracture surgery and to examine the relative market share of hip fracture cases using these surgeon and hospital strata. Methods: We performed a retrospective cohort study in a database of 103,935 patients undergoing hip fracture repair. We generated stratum-specific likelihood ratio (SSLR) models of a receiver operating characteristic (ROC) curve using length of stay (LOS) and cost value metrics. Volume thresholds predictive of decreased LOS and costs for surgeons and hospitals were identified. Results: Analysis of annual surgeon hip fracture volume produced two volume categories for LOS and cost: 0–30 (low) and 31+ (high). Analysis of LOS by annual hospital hip fracture volume produced strata at: 0–59 (low), 60–146 (medium), and 147 or more (high). Analysis of cost by annual hospital volume produced strata at: 0–125 (low) and 126+ (high). LOS and cost both decreased significantly ( p < 0.05) in progressively higher volume categories. Low-volume surgeons performed the majority of hip fracture cases, although they were performed at medium- or high-volume centres. Conclusions: This study demonstrates a direct relationship between volume and value, translating to improvement in hip fracture care delivery for both surgeons and hospitals. Higher volume hospitals while lower volume surgeons perform the majority of hip fracture cases, suggesting optimisation opportunities. However, systems-based practices at the hospital level likely drive value to a greater extent than individual surgeons.

Download Full-text

Abstract 12986: Geriatric Nutritional Risk Index Provides the Additional Long-term Prognostic Information to Gwtg Heart Failure Risk Score in Acute Decompensated Heart Failure Patients With and Without Reduced LVEF

Circulation ◽

10.1161/circ.142.suppl_3.12986 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Tetsuya Watanabe ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Nutritional Status ◽

Risk Score ◽

Risk Index ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Prognostic Information ◽

Poor Outcome ◽

Nutritional Risk Index

Backgrounds: The Get with The Guidelines (GWTG) heart failure (HF) risk score was developed in the GWTG inpatient HF registry to predict in-hospital mortality and has been recently reported to be associated with post-discharge long-term outcomes. Malnutrition is associated with poor outcome in ADHF patients. However, there is no information available on the long-term prognostic significance of the combination of GWTG-HF risk score and malnutrition in patients admitted for ADHF, relating to reduced left ventricular ejection fraction (LVEF). Methods: We studied 303 ADHF patients discharged with survival (HFrEF(LVEF<40%); n=180, HFpEF(LVEF≥40%;n=123). At the admission, we evaluated GWTG-HF score and nutritional status. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, serum levels of blood urea nitrogen and sodium, and the presence of chronic obstructive pulmonary disease. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 · serum albumin (g/dl) + 41.7 · BMI/22, and malnutrition was defined as GNRI<92. The study endpoint was cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. Results: During a follow-up period of 4.2±3.3 yrs, 86 patients had CVR. At multivariate Cox analysis, GWTG-HF risk score and GNRI were significantly and independently associated with CVR, in both HFrEF and HFpEF groups. The patients with both greater GWTG-HF score (>median value=35) and malnutrition had a significantly increased risk of CVR than those with either and none of them ([HFrEF] 60% vs 32% vs 16%, p<0.0001, [HFpEF] 45% vs 18% vs 12%, p<0.0001, respectively) Conclusion: Malnutrition assessed by GNRI would provide the additional long-term prognostic information to GWTG-HF risk score in patients admitted for ADHF, irrespective of the presence of reduced LV function.

Download Full-text