Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture

Abstract

Background Delirium is a common complication in elderly patients with total hip arthroplasty (THA) for hip fracture. The mechanism of postoperative delirium (POD) is associated with the neuroinflammatory process. The aim of this study was to the incidence and perioperative risk factors of POD and investigate whether NLR could serve as a potential marker for POD in elderly patients with THA for hip fracture. Methods This was a multicenter prospective study, we included elderly patients with THA for hip fracture under general anesthesia. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for POD. The relationship between NLR and POD was analyzed by multivariable analysis. Results Seven hundred eighty patients (mean age 73.33 ± 7.66) were eligible for inclusion in the study. 23.33% (182/780) of patients had POD. ROC curve analysis showed that the optimal cut point of NLR for POD was NLR ≥ 3.5. Compared with no POD, higher NLR, older age, diabetes, and higher neutrophil count were more likely in patients with POD(P < 0.05). Multivariate logistic regression analysis showed that NLR ≥ 3.50 [adjusted odds ratio(aOR), 3.93; confidence interval (CI), 2.47–6.25; P < 0.001)], older age (aOR, 1.04; 95%CI, 1.02–1.07; P = 0.001), diabetes (aOR, 1.58; 95% CI, 1.06–2.36; P = 0.025),higher neutrophil count (aOR, 1.25; 95%CI, 1.15–1.35; P < 0.001) were associated with increased risk of POD. Conclusions Older age, diabetes, higher neutrophil count, and NLR ≥ 3.5 were independent risk factors for POD, and NLR can be used as a potential marker for prediction of delirium in elderly patients with THA for hip fracture.

Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study

“…A small pilot study revealed that an increased NLR in acutely ill patients was associated with delirium [ 10 ], and it was proposed that the preoperative NLR can be regarded as a potential marker for the prediction of early-onset delirium after acute ischemic stroke [ 23 ]. A prospective multicenter observational study revealed that a higher preoperative NLR was an independent predictor of POD in patients who underwent total hip arthroplasty [ 14 ]. Two observational studies regarding delirium after cardiac surgery showed that an increased postoperative NLR was associated with POD [ 12 , 13 ].…”

“…Several studies have reported an association between an increased NLR and poor prognosis of various cardiovascular diseases [ 8 , 9 ] and malignancies [ 10 ]. A pilot study showed that the NLR was increased in acutely ill patients with delirium [ 11 ], and several studies showed that a higher preoperative NLR may be associated with the development of POD in patients undergoing cardiac surgery [ 12 ], carotid endarterectomy [ 13 ], and total hip arthroplasty [ 14 ]. In contrast, Ida and colleagues did not find a significant association between POD and the preoperative NLR [ 15 ].…”

Immune, Blood Cell, and Blood Gas Biomarkers of Delirium in Elderly Individuals with Hip Fracture Surgery

“…Our WBC count findings extend the results of previous articles showing abnormal immune-inflammatory responses including increased NLR levels in patients with delirium (see Introduction). For example, Egberts and Mattace-Raso [19] in 2017, Kotfis et al [20] in 2019, and He et al [21] 2020 reported significant positive correlations between an elevated NLR and the emergence of delirium in various patient settings. NLR is relevant index which is useful in surgical emergencies, postoperative complications, and inflammatory conditions [22, 23].…”

Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

“…By far as we know, there has been no study to investigate the incidence and risk factors of postoperative AIS in patients≥70 years old with THA for hip fracture. By comparison, there are more studies on postoperative delirium [ 13 – 15 ], postoperative pneumonia [ 16 – 18 ]. However, with the aggravation of aging in the worldwide, the rising number of THA being performed in elder patients annually, risk factors related to postoperative AIS in these elderly patients should be considered.…”