title: Serum albumin and total lymphocyte count as predictors of outcome in hip fractures.
abstract: OBJECTIVE
  Hip fractures are a significant cause of mortality and morbidity in the elderly. Malnutrition is a significant contributor to this, however no consensus exists as to the detection or management of this condition. We hypothesise that results of admission serum albumin and total lymphocyte count (TLC), as markers of Protein Energy Malnutrition (PEM) can help predict clinical outcome in hip fracture patients aged over 60 years.
  
  
  METHODS
  This retrospective study evaluated the nutritional status of patients with hip fractures using albumin and TLC assays and analysed their prognostic relevance. Clinical outcome parameters studied were delay to operation, duration of in-patient stay, re-admission and in-patient, 3- and 12-month mortality.
  
  
  RESULTS
  Four hundred and fifteen hip fracture patients were evaluated. Survival data were available for 377 patients at 12 months. In-hospital mortality for PEM patients was 9.8%, compared with 0% for patients without. Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters (Odds Ratio 4.6; 95% CI: 1.0-21.3). Serum albumin (Hazard Ratio 0.932, 95% CI: 0.9-1.0) and age (Hazard Ratio 1.04, 95% CI: 1.0-1.1) were found to be significant independent prognostic factors of mortality by Cox regression analysis.
  
  
  CONCLUSIONS
  These results highlight the relevance of assessing the nutritional status of patients with hip fractures at the time of admission and emphasises the correlation between PEM and outcome in these patients.
authors.affiliation: Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. brendan.odaly@ucd.ie
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: O'Daly
authors.forename: James C
authors.initials: JC
authors.lastname: Walsh
authors.forename: John F
authors.initials: JF
authors.lastname: Quinlan
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Falk
authors.forename: Robert
authors.initials: R
authors.lastname: Stapleton
authors.forename: William R
authors.initials: WR
authors.lastname: Quinlan
authors.forename: S Kieran
authors.initials: SK
authors.lastname: O'Rourke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000097:blood* / Q000150:complications / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D018655:Lymphocyte Count / Q000706:statistics & numerical data; D008297:Male; D009752:Nutritional Status; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011502:Protein-Energy Malnutrition / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D012189:Retrospective Studies; D012709:Serum Albumin; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D012709:Serum Albumin