Prognostic Nutritional Index (PNI) as an Independent Predictor of 3-Year Postoperative Mortality in Elderly Patients with Hip Fracture: A Post hoc Analysis of a Prospective Cohort Study.

IF 1.8 2区医学 Q2 ORTHOPEDICS

Orthopaedic Surgery Pub Date : 2024-11-01 Epub Date: 2024-08-14 DOI:10.1111/os.14200

Yimin Chen, Gang Liu, Jing Zhang, Yufeng Ge, Zhelun Tan, Weidong Peng, Feng Gao, Chao Tu, Maoyi Tian, Minghui Yang, Xinbao Wu

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引用次数: 0

Abstract

Objective: The prognostic nutritional index (PNI) has been reported as a significant predictor in various diseases. However, the prognostic value of the PNI in geriatric hip fracture patients has not been thoroughly evaluated. This study aimed to investigate the association between admission PNI and 3-year mortality in those patients.

Methods: In this post hoc analysis, we included patients aged ≥65 years who underwent surgery for hip fracture between 2018 and 2019. The admission PNI was calculated as serum albumin (g/L) +5 × total lymphocyte count (×10⁹/L). Patients were categorized into four groups based on PNI quartiles (≤ 43.55, 43.55-46.55, 46.55-49.20, and >49.20, respectively). The median follow-up duration was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR). Receiver operating characteristic curve (ROC) was conducted for using PNI to predict mortality.

Results: Of the 942 eligible patients, 190 (20.2%) patients died during the follow-up. Compared to patients in the first quartile (Q1), those in the second (Q2), third (Q3), and fourth (Q4) quartiles had significantly lower mortality risks (HRs 0.50, 95% CI 0.35-0.74; 0.41, 95% CI 0.26-0.64; and 0.26, 95% CI 0.15-0.45, respectively). The optimal cutoff of PNI for predicting mortality was set as 45.275 (sensitivity, 0.674; specificity, 0.692; area under the curve (AUC), 0.727). Patients with higher PNI (>45.275) had a significant lower mortality risk (HR 0.39, 95% CI 0.28-0.55) compared to those with lower PNI (≤ 45.275).

Conclusion: PNI is a reliable and independent predictor of 3-year mortality after hip fracture surgery in the elderly.

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预后营养指数（PNI）是老年髋部骨折患者术后 3 年死亡率的独立预测因子：一项前瞻性队列研究的事后分析。

目的据报道，预后营养指数（PNI）是预测各种疾病的重要指标。然而，PNI 在老年髋部骨折患者中的预后价值尚未得到全面评估。本研究旨在调查这些患者的入院 PNI 与 3 年死亡率之间的关系：在这项事后分析中，我们纳入了2018年至2019年期间接受髋部骨折手术的年龄≥65岁的患者。入院 PNI 的计算方法为血清白蛋白（g/L）+5 × 总淋巴细胞计数（×109/L）。根据 PNI 四分位数将患者分为四组（分别为≤43.55、43.55-46.55、46.55-49.20 和 >49.20）。中位随访时间为 3.1 年。Cox比例危险模型用于计算危险比（HR）。利用 PNI 预测死亡率的接收者操作特征曲线（ROC）：在 942 名符合条件的患者中，有 190 人（20.2%）在随访期间死亡。与第一四分位数（Q1）患者相比，第二四分位数（Q2）、第三四分位数（Q3）和第四四分位数（Q4）患者的死亡风险明显较低（HR 分别为 0.50，95% CI 0.35-0.74；0.41，95% CI 0.26-0.64；0.26，95% CI 0.15-0.45）。预测死亡率的最佳 PNI 临界值定为 45.275（灵敏度为 0.674；特异性为 0.692；曲线下面积（AUC）为 0.727）。与 PNI 较低（≤ 45.275）的患者相比，PNI 较高（>45.275）的患者的死亡风险显著降低（HR 0.39，95% CI 0.28-0.55）：结论：PNI是预测老年人髋部骨折术后3年死亡率的可靠且独立的指标。

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来源期刊

Orthopaedic Surgery ORTHOPEDICS-

CiteScore

3.40

自引率

14.30%

发文量

374

审稿时长

20 weeks

期刊介绍： Orthopaedic Surgery (OS) is the official journal of the Chinese Orthopaedic Association, focusing on all aspects of orthopaedic technique and surgery. The journal publishes peer-reviewed articles in the following categories: Original Articles, Clinical Articles, Review Articles, Guidelines, Editorials, Commentaries, Surgical Techniques, Case Reports and Meeting Reports.