Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures

Bingöl, Olgun; Özdemir, Güzelali; Kulakoglu, Burak; Keskin, Ömer Halit; Korkmaz, İzzet; Kılıç, Enver

doi:10.1016/j.injury.2020.07.048

Cited by 13 publications

(13 citation statements)

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“…[15] There are also studies in which NLR, RDW, or NHFS are emphasized for their prognostic value in predicting mortality. [5,6,13,14,24] In previous studies, NLR was significantly correlated with the one-year mortality rate following hip fractures. [27,28] In one of these studies, Forget et al [27] reported that NLR-D5 >5 was a risk factor for postoperative mortality in patients with hip fractures.…”

Section: Discussionmentioning

confidence: 80%

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Karadeniz

Yurtbay

2022

Jt Dis Relat Surg

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The ability to identify patients at high risk for poor outcomes before hip fracture operations is clinically important, as hip fractures may result in mortality or insufficiency in daily living activities in the elderly population. [1] Due to the high mortality rates associated with hip fractures, identifying high-risk patients is critical in terms of treatment management and prevention of a substantial economic burden on healthcare services. [2] In addition, preoperative identification of high-risk patients may be helpful for optimal timing of the operation, administration of critical care during the treatment, preparation of patient-specific informed consent, and developing a better understanding of the prognosis.Objectives: In this study, we aimed to compare the neutrophil-tolymphocyte ratio (NLR), red blood cell distribution width (RDW), and Nottingham Hip Fracture Score (NHFS) according to one-year mortality estimation after hip fracture surgery in elderly.Patients and methods: Between January 2015 and December 2019, a total of 190 elderly patients (63 males, 127 females; mean age: 82.8±6.1 years; range, 70 to 98 years) who were diagnosed with collum femoris fractures treated with hemiarthroplasty were included. The cohort was divided into two groups with NHFS ≤4 and >4 as the low-and high-risk patients, respectively and one-year mortality was assessed for both groups. The RDW was evaluated with blood values sampled on the day of admission. A cut-off of 14.5% was considered for the RDW values. The NLR values calculated on admission (NLR-D0) and postoperative Day 5 (NLR-D5) were considered the primary outcome measures.Results: A total of 46 patients (24.2%) developed any type of complication. The NLR values higher than 5 on Days 0 and 5 were more frequently seen in the complicated patients (p=0.0016 and p<0.001). There were significantly more patients with higher RDW values (>14.5%) in the complicated group (p<0.001). The median NHFS and the rate of patients with NHFS >4 were significantly higher in the complicated patients (p<0.001 for both). The NHFS value higher than 4 had a sensitivity of 87.7% and specificity of 84.0% in predicting mortality (area under the curve [AUC]= 0.910, 95% confidence interval [CI]: 0.860-0.947, p<0.001). Estimation of mortality using an RDW cut-off value of >14.5 showed 87.7% and 80.0% sensitivity and specificity, respectively (95% CI: 0.789-0.904, p<0.001). The AUC of the NLR Day 5 using a cut-off value of >6.8 was 0.953 for the prediction of mortality (95% CI: 0.912-0.978, p<0.001). Conclusion:Age, NLR Day 5 (>5), RDW (>14.5%) and NHFS (>4) were strongly associated with mortality prediction. The NHSF and RDW values had the highest and similar sensitivity merit, while the highest specificity was in NLR-D5. Therefore, NLR, RDW and NHFS values can be used to classify risk factors in estimating one-year mortality rates in elderly patients operated for hip fractures. A multidisciplinary approach should be standardized in determining the risk factors before treatment in patients with...

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Section: Discussionmentioning

confidence: 80%

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Karadeniz

Yurtbay

2022

Jt Dis Relat Surg

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“…In addition, current findings on the relationship between MLR and prognosis in trauma patients are not consistent (Bingol et al, 2020;Djordjevic et al, 2018). In a retrospective analysis of 241 patients with hip fractures, Bingol et al (2020) found that admission MLR could predict 30-day and 1-year mortality with specificity of 81.7% and 85.6% and sensitivity of 78.8% and 68.3%, respectively. However, another prospective study involving 41 trauma patients reported no significant difference in baseline MLR between survivors and nonsurvivors (Djordjevic et al, 2018).…”

Section: Discussionmentioning

confidence: 96%

Association of Monocyte-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios With Persistent Critical Illness in Patients With Severe Trauma

Zhang¹,

Han²,

Chen³

et al. 2022

Journal of Trauma Nursing

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BACKGROUND: Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are reported to reflect the inflammation and immune status in critically ill patients, but their role in severe trauma patients with persistent critical illness remains to be elucidated. OBJECTIVE: We aimed to evaluate the relationship of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio with persistent critical illness in severe trauma patients. METHODS: In a single-center retrospective cohort study, persistent critical illness was defined as intensive care unit length of stay of more than 10 days. Monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were computed individually and categorized into 3 tertiles. Logistic regression analysis was used to assess the relationship of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with persistent critical illness. Receiver operating characteristic curves and the Youden index were used to evaluate the discriminatory threshold of persistent critical illness. RESULTS: A total of 851 eligible patients were enrolled in the study: 328 patients with persistent critical illness and 523 without. The median levels of maximum neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio during intensive care unit stay were all higher in patients with persistent critical illness than in those without (11.46 vs. 9.13, p < .001 and 0.62 vs. 0.46, p < .001). Multivariate analysis revealed that the second (≥0.385, <0.693) and third (≥0.693) maximum monocyte-to-lymphocyte ratio tertiles were significantly associated with persistent critical illness after adjusting for confounding factors (odds ratio: 1.89, 95% confidence interval: 1.10–3.26, p = .021 and odds ratio 2.69, 95% confidence interval: 1.44–5.02, p = .002, respectively), whereas maximum neutrophil-to-lymphocyte ratio was not significantly correlated with persistent critical illness. The area under the curve for the maximum monocyte-to-lymphocyte ratio was 0.63 (95% confidence interval: 0.59–0.67), and the optimal cutoff was 0.65 for persistent critical illness. CONCLUSION: A high maximum monocyte-to-lymphocyte ratio during intensive care unit stay was independently related to persistent critical illness following severe trauma, although with limited sensitivity and specificity.

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“…The neutrophil to lymphocyte ratio and neutrophil counts were established as tools to predict trauma outcome and as markers for complication development. In most studies, high circulating neutrophil counts were associated with a higher risk of complications or postoperative mortality[ 51 - 55 ]. Furthermore, a higher neutrophil count in the blood of trauma patients was identified as a predictor for the development of delayed bone healing[ 56 ].…”

Section: Role Of the Innate Immune Response In Fracture Healingmentioning

confidence: 99%

Effects of immune cells on mesenchymal stem cells during fracture healing

Ehnert¹,

Relja²,

Schmidt‐Bleek³

et al. 2021

WJSC

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In vertebrates, bone is considered an osteoimmune system which encompasses functions of a locomotive organ, a mineral reservoir, a hormonal organ, a stem cell pool and a cradle for immune cells. This osteoimmune system is based on cooperatively acting bone and immune cells, cohabitating within the bone marrow. They are highly interdependent, a fact that is confounded by shared progenitors, mediators, and signaling pathways. Successful fracture healing requires the participation of all the precursors, immune and bone cells found in the osteoimmune system. Recent evidence demonstrated that changes of the immune cell composition and function may negatively influence bone healing. In this review, first the interplay between different immune cell types and osteoprogenitor cells will be elaborated more closely. The separate paragraphs focus on the specific cell types, starting with the cells of the innate immune response followed by cells of the adaptive immune response, and the complement system as mediator between them. Finally, a brief overview on the challenges of preclinical testing of immune-based therapeutic strategies to support fracture healing will be given.

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Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures

Cited by 13 publications

References 24 publications

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Association of Monocyte-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios With Persistent Critical Illness in Patients With Severe Trauma

Effects of immune cells on mesenchymal stem cells during fracture healing

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