Admission Neutrophile to Lymphocyte Ratio and Postoperative Mortality in Elderly Hip Fracture Patients

Abstract

BACKGROUND: Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that the neutrophil-to-lymphocyte ratio (NLR), which is a laboratory marker used to evaluate systemic inflammation, may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission NLR in elderly patients with hip fracture. METHODS: We evaluated patients admitted to the Orthopaedic Surgery Department of Balikesir-Edremit State Hospital. Inclusion criteria were female gender, age between 65 and 80 years, ASA score of 3, unstable intertrochanteric fracture treated with hemiarthroplasty, and time between fracture and surgery less than 72 h. Patients with multiple fracture, previous same side or other side hip surgery, pathological fracture, such as fracture caused by tumor or metabolic bone disease (e.g., Paget's disease), and malignancies were excluded from this study (purposive sampling technique). Finally, "case" (group 1) was defined as patients who died within 1 year after surgery, whereas "control" (group 2) was defined as patients who survived. Patients in group 1 and 2 were statistically compared in terms of NLR value on hospital admission. A total of 22 patients (44%) were included in group 1, and 28 (56%) were included in group 2. RESULTS: We found that the admission NLR values of patients in the mortality group were significantly higher than those of patients in the control group (p<0.001). The cutoff value of NLR was calculated as 4.7 on ROC analysis. CONCLUSION: We believe that the NLR value at admission could be used for risk stratification of mortality in elderly patients with hip fracture.

The Effect of Increased Neutrophil Lymphocyte Ratio on Mortality in Patients Operated on Due to Hip Fracture

“…Forget et al reported that in addition to advanced age, male gender, and comorbid diseases, a postoperative 5th day NLR value >5 following hip fracture surgery was associated with high postoperative mortality risk [3]. Temiz and Ersözlü stated that postoperative NLR ≥4.7 increased the risk of mortality in patients with hip fracture [5]. In our study, NLR was similar between discharged and deceased patients at the preoperative period.…”

Prognostic Factors for All-Cause Mortality in Thai Patients with Fragility Fracture of Hip: Comorbidities and Laboratory Evaluations

“…In prior publications, laboratory evaluation results, including admission hemoglobin concentration, blood level of albumin, and Neutrophil to lymphocyte ratio (NLR), were found to be significantly related to 30-day or 1-year mortality in patients with a hip fracture [ 3 , 16 , 17 , 18 , 26 , 29 ]. Our results showed that an admission hemoglobin concentration of <10 g/dL was a significant predictor of mortality, a finding in concordance with those studies.…”

“…Many factors, including age, gender, physical status, institutionalization, comorbidities, findings of laboratory evaluations, method of treatment, and time to surgery have been reported to be associated with in-hospital, 30-day, and 1-year mortality after a hip fracture in diverse populations and countries [ 3 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. In Thailand, data from Chiang Mai University show factors correlated with mortality after hip fracture in the periods 1997 through 1998, 1998 through 2003, and 2006 through 2007 including male gender, greater age, nonoperative treatment, surgical treatment delayed more than a week, chronic illnesses, poor pre-fracture walking ability, and absence of medical treatment for osteoporosis [ 34 , 35 , 36 ].…”

“…Specific types of comorbidities and laboratory evaluation findings have been identified as major factors associated with mortality after a hip fracture [ 3 , 16 , 17 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 37 , 38 ]. Previous studies of Thai patients, however, have not included these factors in their evaluations of mortality in Thai hip fracture patients [ 34 , 35 , 36 ].…”

“…Previous studies of Thai patients, however, have not included these factors in their evaluations of mortality in Thai hip fracture patients [ 34 , 35 , 36 ]. Additionally, many new factors related to mortality in hip fracture patients have been described in the past decade [ 24 , 25 , 26 , 27 , 29 , 38 ], suggesting the need for a reevaluation of prognostic factors for all-cause mortality after hip fracture.…”