营养控制状况评分预测老年髋部骨折术后患者近期预后的临床价值

Clinical value of controlling nutritional status score in predicting short-term prognosis in elderly patients with hip fracture

目的 探讨营养控制状况(CONUT)评分与老年髋部骨折术后患者近期预后的关系。方法 回顾性分析2020年1月—2021年1月德阳市人民医院骨科收治的老年髋部骨折患者218例,男性55例,女性163例;年龄60~89岁,平均72.1岁;根据患者术后30d内是否出现不良结局事件分为预后良好组(142例)与预后不良组(76例),收集可能影响患者预后的相关影响因素,包括性别、年龄、病史、手术方式、是否输血以及实验室检查指标等,同时记录患者术后30d的随访情况,采用单因素和多因素Logistic回归分析影响患者近期预后的预测因素。结果 老年髋部骨折患者术后30d内随访率为100%,其中死亡21例,病死率9.6%(21/218),发生1种或多种并发症患者55例,并发症发生率25.2%(55/218)。多因素Logistic回归分析显示,年龄增加(OR=1.205,95%CI1.130~1.285,P<0.001)、输血(OR=3.148,95%CI1.392~7.120,P=0.006)和CONUT评分增加(OR=1.653,95%CI1.368~1.997,P<0.001)是老年髋部骨折术后患者近期预后的独立危险因素。结论 围术期CONUT评分可作为老年髋部骨折患者术后近期出现不良结局的预测指标。

Objective To investigate the relationship between the preoperative controlling nutritional status(CONUT)score and clinical prognosis in elderly patients with hip fracture.Methods The clinical data of 218 elderly patients with hip fracture treated in Department of Orthopedics,Deyang Municipal People’s Hospital from Jan.2020 to Jan.2021 were retrospectively analyzed.There were 55 males and 163 females;their age ranged from 60 to 89 years,with an average of 72.1years.According to whether patients had adverse outcomes within 30 days after surgery,they were divided into good prognosis group(n=142)and poor prognosis group(n=76).The relevant factors that may affect the prognosis of the patients were collected,including gender,age,medical history,surgical methods,and laboratory test indicators;the follow-up of the patient within 30 days after surgery was recorded,and univariate and multivariate logistic regression analysis were used to analyze predictors affecting patients’short-term prognosis.Results The follow-up rate of elderly patients with hip fracture within 30 days after operation was 100%.Among them,21 patients died,with a fatality rate of 9.6%(21/218),and 55 patients had one or more complications,with a complication rate of 25.2%(55/218).Multivariate Logistic regression analysis showed that increasing age(OR=1.205,95%CI:1.130-1.285,P<0.001),blood transfusion(OR=3.148,95%CI:1.392-7.120,P=0.006)and increased CONUT score(OR=1.653,95%CI:1.368-1.997,P<0.001)were independent risk factors for the short-term prognosis of elderly patients with hip fractures.Conclusion The perioperative CONUT score can be used as a predictor of adverse postoperative outcomes in elderly patients with hip fractures.