title: Rehabilitation outcome of hip fracture patients: the importance of a positive albumin gain.
abstract: Low serum albumin level is associated with poor functional outcome and predicting a greater functional decline in the elderly. The aim of this study is to determine the interrelation between change of serum albumin level during rehabilitation period and functional outcome in hip fracture patients. We studied 433 consecutive elderly hip fracture patients admitted for rehabilitation. Functional outcome was assessed by the Functional Independence Measure (FIM) at admission and discharge of patients with no albumin gain (<0 g/dl) or with positive albumin gain (>or=0 g/dl). Data were analyzed by t-test, Pearson correlation, chi(2)-test and linear regression. Of patients 66.7% showed no albumin gain. These patients had a higher prevalence of previous stroke (p=0.04), lower Mini Mental State Examination (MMSE) scores (p=0.05) and were less likely to have hyperlipidemia (p=0.008) compared with patients with albumin gains. Admission and discharge FIM parameters and total and motor FIM gain/day were statistically significantly lower among patients with no albumin gain. In a linear regression analysis total FIM at discharge was inversely associated with pre-fracture function (beta=-0.148; p<0.001), Albumin gain (beta=0.047; p=0.005), high MMSE score (beta=0.143; p<0.001), and higher admission total FIM score (beta=0.69; p<0.001) emerged as significant predictors of higher total FIM scores upon discharge. The results suggest that patients with albumin gain have better admission and discharge FIM scores. Albumin gain emerged as a significant predictor for higher discharge FIM scores. We conclude that greater attention and efforts should be made regarding the dietary intervention and protein supplementation, in order to improve the rehabilitation outcome.
authors.affiliation: Department of Geriatric Medicine and Rehabilitation, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. exm42@sheba.health.gov.il
authors.forename: E H
authors.initials: EH
authors.lastname: Mizrahi
authors.forename: Y
authors.initials: Y
authors.lastname: Fleissig
authors.forename: M
authors.initials: M
authors.lastname: Arad
authors.forename: T
authors.initials: T
authors.lastname: Blumstein
authors.forename: A
authors.initials: A
authors.lastname: Adunsky
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000534:rehabilitation*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000534:rehabilitation*; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D007557:Israel; D016014:Linear Models; D008297:Male; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D011859:Radiography; D020127:Recovery of Function / Q000502:physiology; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D015415:Biomarkers