Survival of patients after a hip fracture: Influence of previous nutritional status on outcomes

Sarcopenia is a highly prevalent condition in patients with hip fracture; this condition can be related with prognosis. The main aim of this study was to investigate the survival rate of hip fracture inpatients and factors associated with mortality after six months and five years of the fracture event.

A real-world prospective study was carried out on 186 patients aged 75 years and older admitted after hip fracture, which were assessed within 48 h previous to surgical intervention. Hospitalized patients were able to walk before the fracture and showed no signs of cognitive impairment or chronic degenerative pathologies that posed a high risk of mortality. Integral Geriatric Assessment (IGA) was carried out at admission, at discharge, and after one, three and six months. Handgrip strength (HGS) was tested and lean tissue estimated through Bioelectrical Impedanciometry Analysis (BIA). Follow-up of all patients was carried out in order to record survival status or decease date. Mini-Nutritional Assessment (MNA) and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were recorded to assess disease-related malnutrition (DRM) and sarcopenia.

Age was 86.2 (75-104) years, with 81.7 % of women. Sarcopenia prevalence was of 59,1 % (with 76.9 % of patients showing low HGS and 73,7 % low estimated lean soft tissue. DRM was established in 81.2 % of patients, with 48,9 % of them showing both malnutrition and sarcopenia. Mortality within the first six months was 12.3 % increasing to 14,5 % and 51,6 % after one- and five-years follow-up respectively.The multivariate analyses identified the following significant factors associated with mortality across all subgroups: low handgrip (OR 3.61, 95 % CI (1.55-8.44; p < 0.01), age >85 years (OR 2.44; CI 1.24-4.81; p = 0.01), Barthel index at admission <60 (OR 0.47, 95%CI 0.22-0.99; p = 0.049, and BMI <22 kg/m² (OR 0.26; 95 % CI: 0.12-0.59; p < 0.01)) CONCLUSIONS: Over half of hip fracture patients exhibit sarcopenia, with 81 % experiencing DRM, and nearly 50 % presenting both conditions simultaneously. Mortality at six months and five years is associated with sarcopenia, poorer nutritional status at the time of hospitalization, and a lower prefracture functional status.