The combined effect of controlling nutritional status increase and activities of daily living impairment on 12-month mortality of older adults after hip fracture: a retrospective cohort study

Objective We aimed to explore the combined effect of nutritional status and functional autonomy was associated with all-cause mortality of older adults with hip fracture patients in the first year after hospitalization. Methods This is a single-center retrospective cohort study in older adults with hip fracture patients. Clinical data and laboratory results were collected from electronic medical record system of our hospital (2014–2021). The endpoint of this study was all-cause mortality in the first year after hospitalization. Results A total of 303 older adults were enrolled and all-cause mortality was 21.8%. Compared with patients who were alive at 1 year, those who died were older, had less body mass index (BMI), activities of daily living (ADL), hemoglobin, lymphocytes, total protein, albumin, triglycerides and total cholesterol. They also had higher age, C-reactive protein (CRP) and Controlling nutritional status (CONUT) score. Multivariable Cox analysis showed that BMI, ADL and CONUT were independent risk factors for all-cause mortality of hip fracture in elderly (HR (95% CI):2.808(1.638, 4.814), P < 0.001; 2.862(1.637, 5.003), P < 0.001; 2.322(1.236, 4.359), P = 0.009, respectively). More importantly, the combined index of CONUT and ADL had the best predictive performance based on ROC curve (AUC 0.785, 95% CI: 0.734–0.830, P < 0.0001). Kaplan-Meier survival curves for all-cause mortality showed that patients with CONUT increase and ADL impairment had a higher mortality rate at 1 year compared to CONUT decrease and ADL well (Log Rank χ2 = 45.717, P < 0.0001). Conclusions Combined index of CONUT increase and ADL impairment has good clinical value in assessing 1-year postoperative prognosis in older adults after hip fracture.