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Observational Study
. 2024 Dec 11;16(24):4280.
doi: 10.3390/nu16244280.

Predictive Feasibility of the Graz Malnutrition Screening, Controlling Nutritional Status Score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index for Postoperative Long-Term Mortality After Surgically Treated Proximal Femur Fracture

Domenik Popp  1   2 , Marie Stich-Regner  1 , Lukas Schmoelz  1 , Sara Silvaieh  3 , Stephan Heisinger  1 , Arastoo Nia  1   2
Affiliations
Observational Study

Predictive Feasibility of the Graz Malnutrition Screening, Controlling Nutritional Status Score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index for Postoperative Long-Term Mortality After Surgically Treated Proximal Femur Fracture

Domenik Popp et al. Nutrients. .

Abstract

Background: Hip fractures are a prevalent and serious health issue, particularly among the elderly population aged >65 years. These injuries are associated with elevated rates of postoperative complications and mortality, significantly diminishing patients' quality of life in both the short- and long-term. The prognosis for recovery is further exacerbated in individuals with signs of malnutrition. The primary objective of this study was to evaluate the predictive value of four distinct nutritional assessment scores in relation to postoperative mortality in patients undergoing surgical intervention for hip fractures at 1, 3, 6, 12, and 24 months.

Methods: This observational study included patients admitted to the Department of Traumatology at the Medical University for the surgical management of hip fractures between January 2019 and November 2021. Nutritional assessment scores were derived from a retrospective analysis of clinical data. The statistical correlation between nutritional scores and postoperative mortality outcomes was rigorously evaluated.

Results: Logistic regression analysis revealed a statistically significant correlation (p < 0.01) between all four nutritional scores and postoperative mortality risk. The malnourished cohorts demonstrated a markedly higher risk of mortality compared to those with adequate nutritional status, as indicated by the following risk ratios: Graz Malnutrition Screening (risk ratio = 2.53-1.68), Prognostic Nutritional Index (risk ratio = 2.44-1.74), Geriatric Nutritional Risk Index (risk ratio = 2.05-1.58), and Controlling Nutritional Status (risk ratio = 2.34-1.46). Despite these findings, the receiver operating characteristic analysis yielded area under the curve (AUC) values ranging from 0.64 to 0.68, indicating limited predictive power.

Conclusions: Although a significant correlation existed between the evaluated nutritional scores and postoperative mortality, the predictive value of these scores was quantitatively low. No single nutritional assessment tool has emerged as a strong predictor of postoperative outcomes in this patient population. Consequently, implementation of any specific nutritional screening tool for standard assessment in patients with hip fractures is not recommended at this time. Nevertheless, given the established association between malnutrition and postoperative mortality, a comprehensive evaluation of nutritional status is advisable and further research is needed.

Keywords: CONUT; GMS; GNRI; PNI; hip fracture; malnutrition; mortality; risk prediction.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
(a–d): Conditional density plots of the used screening tools including cut-off values for mortality prediction.
Figure 2
Figure 2
(a–e): AUC for mortality-prediction at 1, 3, 6, 12, and 24 months.
See this image and copyright information in PMC

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