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Serum Albumin and Total Lymphocyte Count as Predictors of Morbidity and Mortality in Geriatric Hip Fracture Patients: A Review of the Current Literature

1 August 2007


Background: The proportion of the us and world population over the age of 65 is increasing rapidly and will double in the next 30 years. With this increase in elderly, health care providers can expect an increase in the incidence of patients with hip fracture. Hip fractures incur high rates of morbidity and mortality on the patients who experience them. If accurate prognostic tools can be applied, certain subgroups of elderly hip fracture patients will be more likely to get the specific care they need to maximize recoveries.

Study Design: This review investigates current literature addressing the potential usefulness of two nutritional markers-serum albumin and total lymphocyte count-as predictors of morbidity and mortality in elderly hip fracture patients. It includes recent and relevant articles found electronically on Medline-Ovid, Medline-FirstSearch, and CINAHL databases, as well as in the "references" sections of works found electronically.

Results: Symeonidis et al20 found that subnormal levels of serum albumin and total lymphocyte counts resulted in increased time from admission to surgery, as well as increased one-year mortality when compared to subjects with normal levels of both parameters. Koval et al 23 demonstrated that subnormal levels of serum albumin predicted increased length of hospital stay and in-hospital mortality. Subjects with subnormal total lymphocyte counts were more likely to have died within twelve months of surgery. Subjects with subnormal levels of both values were 2.9 times more likely to have a hospital stay over two weeks, 3.9 times more likely to die within twelve months of surgery, and 4.6 times less likely to reach pre-fracture levels of functioning in activities of daily living and instrumental activities of daily living. Burness et al 24 found that serum albumin levels of subjects who had died by twelve months after hip surgery were significantly lower than the serum albumin levels of those subjects alive at one year. Pioli et al 25 demonstrated that subnormal levels of serum albumin were predictive for increased in-hospital, six-month, and one-year mortality in geriatric hip fracture patients. Conlan et al 26 found that total lymphocyte counts were significantly lower in subjects who had died six months after undergoing surgery for hip fracture than in an equal number of matched control subjects.

Conclusions: Although not found universally, several well-designed studies have shown that serum albumin and total lymphocyte counts, either alone, or in combination, predicted morbidity and mortality rates in elderly hip fracture patients. Additional investigations are necessary to further validate these two nutritional markers as prognostic indicators. Future studies should focus on attaining large, population-based subject groups with data collected in a prospective fashion.


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