Estudio de sarcopenia en pacientes mayores de 74 años con fractura de la extremidad proximal del fémur.
Hip fracture is a pathology with a high incidence in the elderly patient and entails significant functional deterioration and increased mortality. In geriatric patients who suffer a fracture, various pathological processes coexist that will influence their evolution. Sarcopenia, malnutrition and fra...
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| Formato: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2023 |
| País: | España |
| Recursos: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/59783 |
| Acesso em linha: | https://doi.org/10.35376/10324/59783 https://uvadoc.uva.es/handle/10324/59783 |
| Access Level: | acceso abierto |
| Palavra-chave: | Geriatrics Sarcopenia Malnutrition Desnutrición Fragility Fragilidad 3201.0 Geriatría |
| Resumo: | Hip fracture is a pathology with a high incidence in the elderly patient and entails significant functional deterioration and increased mortality. In geriatric patients who suffer a fracture, various pathological processes coexist that will influence their evolution. Sarcopenia, malnutrition and frailty are becoming increasingly important. The Comprehensive Geriatric Assessment (VGI) and the intervention based on it is basic in these patients. OBJECTIVES: The main objective of this study was to determine the prevalence of sarcopenia, malnutrition and frailty in this population, the factors that could be related to these geriatric syndromes and the relationship between them. We also set out to evaluate the impact of a multicomponent intervention (nutritional intervention and physical exercise). MATERIAL AND METHODS: A prospective study of routine clinical practice was carried out on 186 patients older than 74 years who were admitted for fragility fracture and who could be evaluated in the first 48 hours of admission and before being operated on. The patients previously walked, did not present severe cognitive impairment and did not suffer from chronic degenerative pathology with a high probability of death. On admission, at discharge, in the first, third, and sixth months, VGI was performed, handgrip strength was measured, muscle mass was estimated by bioimpedance analysis (BIA), and general analysis was obtained, which included determination of vitamin D and parathormone, in addition to proteins, lipids and renal function. The diagnosis of frailty was made by FRAIL, we used the Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of disease-related malnutrition (DRE) and the sarcopenia criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2 ). RESULTS: The mean age was 86.2 (75-104) years, 81.7% were women. The prevalence of confirmed sarcopenia was 59.14%, 76.9% of the sample had low grip strength and 73.65% had low muscle mass. 81.2% were diagnosed with DRE and 48.92% suffered from malnutrition and sarcopenia. According to FRAIL, 35.48% met the criteria for the diagnosis of physical frailty. Patients diagnosed with sarcopenia were older (88.1 (5.5) years vs 84.9 (5.2) years p<0.01), had a higher burden of disease (CIRS-G 10.1( 4.3) vs 7.9 (4.2) p<0.01, had lost more weight (p<0.01), had a lower BMI (body mass index) (21.4(2.9) vs 25.4(4.2) p<0.01), lower scores in MNA (Mini-Nutritional Assessment) (p<0.01) and worse previous functional situation measured by Barthel (p=0.02). In the 6-month follow-up, the prevalence of sarcopenia (59.14% vs 16.5% p<0.01) and frailty (35.48 vs 20.1% p<0.01) decreased, the improvement of hadgrip strength and muscular mass was only significant in women. In the multivariate analysis, the variables related to survival were: confirmed sarcopenia (OR 2.40 (1.7-7.3) p<0.01), handgrip strength (OR 4.58 (1.04- 21.16) p<0.01), frailty (OR: 8.64(2.32-32.18) p<0.01) and age (OR: 1.30(1.10-1.53) p< 0.01). Confirmed sarcopenia decreased significantly in those who took oral nutritional supplementation (p<0.01). CONCLUSIONS: More than half of the patients with hip fracture present sarcopenia and 81% of these patients have DRE, both syndromes coinciding in half of the cases in the same patient. The diagnosis of sarcopenia is more frequent in older patients, with a greater burden of disease, a worse previous functional situation, greater weight loss and a lower BMI, as well as lower MNA scores. Mortality at six months is related to the presence of sarcopenia, worse nutritional status at admission, frailty, and worse previous functional status. Taking an oral nutritional supplement is related to an improvement in both malnutrition and sarcopenia. |
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