Relationship between perioperative nutrition risk and venous thromboembolism in patients with hip fracture

doi:10.11958/20230273

Abstract

Abstract:

Objective To investigate the relationship between perioperative nutritional risk and venous thromboembolism (VTE) in patients with hip fracture. Methods A total of 379 patients with unilateral hip fracture due to fall or sprain who underwent elective surgery were selected and divided into the non-VTE group (246 cases) and the VTE group (133 cases) according to whether or not VTE occurred during perioperative period. Basic information, surgical and anesthesia records, nutritional risk related indicators, inflammatory indicators and outcome indicators of patients were collected. Multiple Logistic regression was used to analyze the independent influencing factors of perioperative VTE. Receiver operating characteristics (ROC) curves were used to assess the ability to discriminate independent factors, and DeLong test was used to compare area under the curve (AUC). Results Compared with the non-VTE group, the proportion of patients in the VTE group was older, complicated with hypertension, the time to visit hospital more than 2 days, received (hollow/intramedullary nail) internal fixation, perioperative blood transfusion, ASA grade Ⅲ to Ⅳ, and higher nutritional risk screening Table (NRS) -2002 scores on admission and higher postoperative neutrophil/lymphocyte ratio (NLR). Nutritional prognosis index (PNI), hemoglobin (Hb) and prealbumin (PA) at admission and after operation were lower in the VTE group than those in the non-VTE group (P<0.01). Multivariate Logistic regression analysis showed that PNI was decreased, NRS-2002 scores and PA were increased, and the time of visit hospital was > 2 days after internal fixation. American College of Anesthesiologists (ASA) grades Ⅲ-Ⅳ were independent risk factors for perioperative VTE of hip fracture (P<0.05). ROC curve analysis showed that the AUC (95%CI) of NRS-2002 at admission was 0.739 (0.692-0.783), and that of PNI at admission was 0.720 (0.672-0.765), both of which were better than other influencing factors (P<0.01). Conclusion NRS-2002 and PNI are good predictors of perioperative VTE in patients with hip fracture.

Key words: venous thromboembolism, hip fractures, perioperative period, nutritional risk screening-2002, prognostic nutritional index

CLC Number:

R614，R151

Figures/Tables 4

References 29

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变量	β	SE	Wald χ²	P	OR	OR95%CI
手术方式	1.087	0.309	12.385	<0.001	2.965	1.618~5.430
入院时PNI	-0.107	0.039	7.539	0.006	0.898	0.832~0.970
入院时NRS-2002评分	0.480	0.179	7.228	0.007	1.617	1.139~2.295
就诊时间	0.657	0.288	5.204	0.023	1.929	1.097~3.391
入院时PA	0.006	0.003	4.804	0.028	1.006	1.001~1.012
ASA分级	0.635	0.302	4.413	0.036	1.888	1.043~3.415

变量	β	SE	Wald χ²	P	OR	OR95%CI
手术方式	1.087	0.309	12.385	<0.001	2.965	1.618~5.430
入院时PNI	-0.107	0.039	7.539	0.006	0.898	0.832~0.970
入院时NRS-2002评分	0.480	0.179	7.228	0.007	1.617	1.139~2.295
就诊时间	0.657	0.288	5.204	0.023	1.929	1.097~3.391
入院时PA	0.006	0.003	4.804	0.028	1.006	1.001~1.012
ASA分级	0.635	0.302	4.413	0.036	1.888	1.043~3.415

指标	AUC（95%CI）	敏感度（%）	特异度（%）	约登指数	截断值	Z^a	Z^b
入院时NRS-2002评分	0.739（0.692~0.783）	72.18	73.17	0.454	3分		0.798
入院时PNI	0.720（0.672~0.765）	60.90	73.98	0.349	39.98	0.798
ASA分级	0.597（0.546-0.647）	36.09	83.33	0.194		4.537^＊＊	3.636^＊＊
入院时PA	0.590（0.539~0.640）	38.35	79.67	0.180	137.5 mg/L	4.901^＊＊	4.864^＊＊
手术方式	0.588（0.536~0.638）	64.66	52.85	0.175		4.072^＊＊	3.718^＊＊
就诊时间	0.555（0.504~0.606）	39.10	71.95	0.111		5.406^＊＊	4.587^＊＊

指标	AUC（95%CI）	敏感度（%）	特异度（%）	约登指数	截断值	Z^a	Z^b
入院时NRS-2002评分	0.739（0.692~0.783）	72.18	73.17	0.454	3分		0.798
入院时PNI	0.720（0.672~0.765）	60.90	73.98	0.349	39.98	0.798
ASA分级	0.597（0.546-0.647）	36.09	83.33	0.194		4.537^＊＊	3.636^＊＊
入院时PA	0.590（0.539~0.640）	38.35	79.67	0.180	137.5 mg/L	4.901^＊＊	4.864^＊＊
手术方式	0.588（0.536~0.638）	64.66	52.85	0.175		4.072^＊＊	3.718^＊＊
就诊时间	0.555（0.504~0.606）	39.10	71.95	0.111		5.406^＊＊	4.587^＊＊