Association between Increased Neutrophil-To-Lymphocyte Ratio and Postoperative 1-Year Mortality in Elderly Patients with Pertrochanteric Hip Fracture
Year 2024,
Volume: 8 Issue: 2, 223 - 228, 27.08.2024
Hicabi Sezgin
,
Furkan Erdoğan
,
Özkan Öztürk
,
Emre Çalışal
Abstract
Purpose: This study aimed to examine the prognostic value of perioperative NLR level in terms of mortality in the first postoperative year in elderly patients undergoing hip fracture surgery.
Materials and Methods: The study included 236 patients (68.6% female and 31.4% male) who met the specified criteria and had undergone hip fracture surgery. Complete blood counts were recorded at admission and on the fifth postoperative day. Neutrophil-to-lymphocyte ratios (NLR) at admission (NLR-D0) and on the fifth postoperative day (NLR-D5) were identified as the primary variables.
Results: The mean age of the participants was 80.1±7.9 years (min: 65 years to max: 99 years). The mean NLR-D0 and mean NLR-D5 values of surviving patients were 6.54 and 4.55, respectively. The mean NLR-D0 and mean NLR-D5 values of patients who died were 6.99 and 8.90, respectively. A significant difference was found in the NLR variability of the patients who survived and those who died. The examination of the effects of NLR-D0 and NLR-D5 parameters on mortality revealed no significant difference in NLR-D0 values between the patients who lived and those who died (p>0.05), but the NLR-D5 value was significantly higher in the patients who died. The mortality rate at the end of the first postoperative year was 35.2%.
Conclusion: A high NLR value (NLR-D5>7.85) on the fifth postoperative day in elderly patients undergoing hip fracture surgery may be a predictor of 1-year mortality after hip fracture surgery.
Ethical Statement
The author declares that there is no conflict of interest. This study was found ethically appropriate by the Ahi Evran University Clinical Research Ethics Committee on 09.04.2020 with the decision number KAEÜKAEK 2020-06/44. No budget was used for the study.
Supporting Institution
None
References
- 1. Tajeu GS, Delzell E, Smith W, et al. Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci. 2014;69(3):346-353.
- 2. Morley JE, Vellas B, Van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-397.
- 3. Winters A, Hartog L, Roijen H, et al. Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture. Clin Interv Aging. 2018;13(1):2481-2486.
- 4. Ahbap E, Sakaci T, Kara E, et al. Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clin Nephrol. 2016;85(4):199-208.
- 5. Hajibandeh S, Hajibandeh S, Hobbs N, et al. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. Am J Surg. 2020;219(1):154-163.
- 6. Fisher A, Srikusalanukul W, Fisher L, Smith P. The neutrophil to lymphocyte ratio on admission and short-term outcomes in Orthogeriatric patients. Int J Med Sci. 2016;13(8):588-602.
- 7. De Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7(10): e46561.
- 8. Emektar E, Çorbacıoğlu ŞK, Dağar S, et al. Prognostic value of the neutrophil–lymphocyte and platelet–lymphocyte ratios in predicting one-year mortality in patients with hip fractures and aged over 60 years. Eurasian J Emerg Med. 2017;16(4):165-170.
- 9. Alexandru L, Haragus H, Deleanu B, et al. Haematology panel biomarkers for humeral, femoral, and tibial diaphyseal fractures. Int Orthop. 2019;43(7):1567-1572.
- 10. Niessen R, Bihin B, Gourdin M, et al. Prediction of postoperative mortality in elderly patient with hip fractures: a single-centre, retrospective cohort study. BMC Anesthesiol. 2018;18(1):183.
- 11. Pop DV, Daliborca CV, Radu D, et al. Lymphocyte and Neutrophil to Lymphocyte Ratio do not Predict Mortality in Hip Fracture Patients. Rev. Chim. 2019;70(8):2854-2856.
- 12. Özbek EA, Ayanoğlu T, Olçar HA, et al. Is the preoperative neutrophil-to-lymphocyte ratio a predictive value for postoperative mortality in orthogeriatric patients who underwent proximal femoral nail surgery for pertrochanteric fractures? Ulus Travma Acil Cerrahi Derg. 2020;26(4):607-612.
- 13. Forget P, Moreau N, Engel H, et al. The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF). Arch Gerontol Geriatr. 2015;60(2):366-371.
- 14. Temiz A, Ersözlü S. Admission neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture. Ulus Travma Acil Cerrahi Derg. 2019;25(1):71-74.
- 15. Aydın İ, Ağıllı M, Aydın FN, et al. Farklı yaş gruplarında nötrofil/lenfosit oranı referans aralıkları. Gülhane Tıp Derg. 2015;57(4):414-418.
- 16. Forget P, Khalifa C, Defour J-P, et al. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.
- 17. Golsorkhtabaramiri M, Mckenzie J, Potter J. Predictability of Neutrophil to Lymphocyte Ratio in preoperative elderly hip fracture patients for post-operative short-term complications: a retrospective study. BMC Musculoskelet Disord. 2023;24(1):227.
- 18. Zhou J, Fu J, Zhao Q, et al. Effect of neutrophil-to-lymphocyte ratio on short-term prognosis of elderly patients with hip fracture. Am J Transl Res. 2021;13(8):9222-9228.
- 19. Palmer J, Pandit V, Zeeshan M, et al. The acute inflammatory response after trauma is heightened by frailty: A prospective evaluation of inflammatory and endocrine system alterations in frailty. J.Rauma Acute Care Surg. 2019;87(1):54-60.
- 20. Desborough J. The stress response to trauma and surgery. Br. J. Anaesth. 2000;85(1):109-117.
- 21. Sedlář M, Kvasnička J, Krška Z, Tománková T, Linhart A. Early and subacute inflammatory response and long-term survival after hip trauma and surgery.Arch Gerontol Geriatr. 2015;60(3):431-436.
Pertrokanterik Kalça Kırığı Geçiren Yaşlı Hastalarda Yüksek Nötrofil-Lenfosit Oranı ile Postoperatif 1 Yıllık Mortalite Arasındaki İlişki
Year 2024,
Volume: 8 Issue: 2, 223 - 228, 27.08.2024
Hicabi Sezgin
,
Furkan Erdoğan
,
Özkan Öztürk
,
Emre Çalışal
Abstract
Amaç: Araştırma, yaşlı hastalarda kalça kırığı ameliyatı geçiren bireylerde perioperatif nötrofil/lenfosit oranının (NLR) mortalite üzerindeki prognostik değerini incelemeyi amaçlamaktadır.
Araçlar ve Yöntem: Çalışmaya dahil edilen 236 hasta (%68.6 kadın ve %31.4 erkek), belirlenen kriterlere uyan ve kalça kırığı ameliyatı geçiren bireylerden oluşmaktadır. Hastaların kabul anındaki tam kan sayımı ve beşinci postoperatif günkü değerleri kaydedilmiştir. Kabul anındaki (NLR-D0) ve beşinci postoperatif günkü (NLR-D5) NLR değerleri ana değişken olarak belirlenmiştir.
Bulgular: Hastaların yaş ortalaması 80.1±7.9 yıldır (65-99). Hayatta kalan hastaların ortalama NLR-D0 ve NLR-D5 değerleri sırasıyla 6.54 ve 4.55'tir. Vefat eden hastaların ise ortalama NLR-D0 ve NLR-D5 değerleri sırasıyla 6.99 ve 8.90'dır. Hayatta kalanlar ve vefat edenler arasında NLR açısından anlamlı bir fark bulunmuştur. NLR-D0 değerlerinin yaşayanlar ve ölenler arasında anlamlı bir fark oluşturmadığı, ancak NLR-D5 değerinin ölenlerde belirgin şekilde yüksek olduğu görülmüştür. Birinci postoperatif yıl sonundaki mortalite oranı %35.2'dir.
Sonuç: Kalça kırığı ameliyatı geçiren yaşlı hastalarda beşinci postoperatif gündeki yüksek NLR değeri (NLR-D5>7.85), 1 yıllık mortaliteyi öngörmede bir belirleyici olabilir.
References
- 1. Tajeu GS, Delzell E, Smith W, et al. Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci. 2014;69(3):346-353.
- 2. Morley JE, Vellas B, Van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-397.
- 3. Winters A, Hartog L, Roijen H, et al. Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture. Clin Interv Aging. 2018;13(1):2481-2486.
- 4. Ahbap E, Sakaci T, Kara E, et al. Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clin Nephrol. 2016;85(4):199-208.
- 5. Hajibandeh S, Hajibandeh S, Hobbs N, et al. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. Am J Surg. 2020;219(1):154-163.
- 6. Fisher A, Srikusalanukul W, Fisher L, Smith P. The neutrophil to lymphocyte ratio on admission and short-term outcomes in Orthogeriatric patients. Int J Med Sci. 2016;13(8):588-602.
- 7. De Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7(10): e46561.
- 8. Emektar E, Çorbacıoğlu ŞK, Dağar S, et al. Prognostic value of the neutrophil–lymphocyte and platelet–lymphocyte ratios in predicting one-year mortality in patients with hip fractures and aged over 60 years. Eurasian J Emerg Med. 2017;16(4):165-170.
- 9. Alexandru L, Haragus H, Deleanu B, et al. Haematology panel biomarkers for humeral, femoral, and tibial diaphyseal fractures. Int Orthop. 2019;43(7):1567-1572.
- 10. Niessen R, Bihin B, Gourdin M, et al. Prediction of postoperative mortality in elderly patient with hip fractures: a single-centre, retrospective cohort study. BMC Anesthesiol. 2018;18(1):183.
- 11. Pop DV, Daliborca CV, Radu D, et al. Lymphocyte and Neutrophil to Lymphocyte Ratio do not Predict Mortality in Hip Fracture Patients. Rev. Chim. 2019;70(8):2854-2856.
- 12. Özbek EA, Ayanoğlu T, Olçar HA, et al. Is the preoperative neutrophil-to-lymphocyte ratio a predictive value for postoperative mortality in orthogeriatric patients who underwent proximal femoral nail surgery for pertrochanteric fractures? Ulus Travma Acil Cerrahi Derg. 2020;26(4):607-612.
- 13. Forget P, Moreau N, Engel H, et al. The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF). Arch Gerontol Geriatr. 2015;60(2):366-371.
- 14. Temiz A, Ersözlü S. Admission neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture. Ulus Travma Acil Cerrahi Derg. 2019;25(1):71-74.
- 15. Aydın İ, Ağıllı M, Aydın FN, et al. Farklı yaş gruplarında nötrofil/lenfosit oranı referans aralıkları. Gülhane Tıp Derg. 2015;57(4):414-418.
- 16. Forget P, Khalifa C, Defour J-P, et al. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.
- 17. Golsorkhtabaramiri M, Mckenzie J, Potter J. Predictability of Neutrophil to Lymphocyte Ratio in preoperative elderly hip fracture patients for post-operative short-term complications: a retrospective study. BMC Musculoskelet Disord. 2023;24(1):227.
- 18. Zhou J, Fu J, Zhao Q, et al. Effect of neutrophil-to-lymphocyte ratio on short-term prognosis of elderly patients with hip fracture. Am J Transl Res. 2021;13(8):9222-9228.
- 19. Palmer J, Pandit V, Zeeshan M, et al. The acute inflammatory response after trauma is heightened by frailty: A prospective evaluation of inflammatory and endocrine system alterations in frailty. J.Rauma Acute Care Surg. 2019;87(1):54-60.
- 20. Desborough J. The stress response to trauma and surgery. Br. J. Anaesth. 2000;85(1):109-117.
- 21. Sedlář M, Kvasnička J, Krška Z, Tománková T, Linhart A. Early and subacute inflammatory response and long-term survival after hip trauma and surgery.Arch Gerontol Geriatr. 2015;60(3):431-436.