Combined Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) predict survival in elderly patients with hip fractures: a retrospective study

Abstract

Purpose The Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) have undergone comprehensive examination and validation in forecasting the outcomes of diverse medical conditions. Nevertheless, the correlation between the combined use of GNRI and SII metrics and hip fractures has yet to be elucidated. This study aimed to determine whether the amalgamation of SII and GNRI scores constitutes an independent prognostic factor for elderly patients with hip fractures. Methods We conducted a retrospective analysis of elderly patients admitted to our facility with hip fractures, encompassing both femoral neck and intertrochanteric fractures. Demographic information, experimental parameters, and postoperative complications were systematically recorded. The Geriatric Nutritional Risk Index (GNRI) and Systemic Immunoinflammatory Index (SII) were meticulously computed. Receiver operating characteristic (ROC) curves were generated, and optimal cutoff values for each parameter were determined. Subsequently, a multivariate Cox regression analysis was employed to assess the predictive utility of the SII–GNRI score in relation to 1-year postoperative mortality among elderly patients with hip fractures. Results In a study involving 597 patients, 90 of whom experienced mortality within 1 year, it was observed that the SII-GNRI score in the group of patients who passed away was significantly higher compared to the group that survived. Following a multifactorial adjustment, it was established that a high SII–GNRI score served as an independent predictor of 1-year all-cause mortality in older patients with hip fractures. In addition to the SII–GNRI score, factors such as length of hospital stay, CCI > 2, and blood transfusion were also identified as independent risk factors for survival. Notably, the incidence of postoperative complications in patients with high SII–GNRI scores was significantly greater than in patients with low scores. Conclusion The SII–GNRI score proves valuable in predicting the 1-year survival rate for elderly patients with hip fractures who have undergone surgery.

Prognostic value of the systemic immune-inflammation index in critically ill elderly patients with hip fracture: evidence from MIMIC (2008–2019)

“…The nature of reduced physiological reserve in elderly patients makes them more vulnerable to post-injury release of aggressive cytokines (TNF-a, IL-6, and IL-1β, etc. ), as well as the lack of sufficient anti-invasive mediators to counterbalance their negative effects (3). After a hip fracture, the hip fracture-induced plasma mitochondrial dried DNA (mtDNA) release leads to a systemic hyperinflammatory response and lung damage via activating the TLR9/NF-KB pathway, a process that has also been termed the "inflammatory storm" (43)(44)(45)(46).…”

“…Approximately 9% of general patients succumb within a month, and this figure escalates to a staggering 36% for mortality within a year’s timeframe ( 2 ). Some researchers suggest that the elevated mortality rate of hip fractures is linked to the patient’s pathological and behavioral status, including nutritional deficiencies, immune system functioning, and the diminishment of skeletal muscle mass ( 3 ). Several studies have provided similar elucidation of the relationship between hip fracture mortality and immune health, particularly the inflammatory response ( 4 ).…”

“…The SII provides a convenient and effective method for examining immunological dysfunction and the activation of systemic inflammation ( 13 , 14 ). Prior research has mostly concentrated on evaluating SII levels in the general population to forecast adverse outcomes in hip fracture disease ( 3 , 5 ). Several studies have found a significant link between high SII levels, inflammation advancement, and higher mortality rates for fractures ( 15 ).…”