The relationship between inflammatory markers and mortality in patients undergoing proximal femoral nail fixation for intertrochanteric femur fractures

Yıl 2024, , 76 - 82, 27.01.2024

Murat Danışman , Azime Bulut

https://doi.org/10.21673/anadoluklin.1363996

Öz

Aim: This study aimed to investigate the predictability of mortality based on biomarkers measured using complete blood count in geriatric patients who underwent proximal femoral nail fixation for intertrochanteric femur fractures.

Methods: We included in this retrospective study 247 patients who had undergone proximal femoral nailing due to osteoporotic intertrochanteric femur fracture. The patients were divided into two groups according to 1-year mortality outcome: group A, survivors (n=162), and group B, deceased patients (n=85). Preoperative demographic information, the number of days until surgery, C-reactive protein (CRP) level, hemoglobin level, platelet-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammatory index (SII) were recorded.

Results: No statistically significant differences were found between the groups in terms of sex, type of anesthesia, leukocyte count, and neutrophil level (p>0.05), but statistically significant differences were found in age, number of days until surgery, CRP level, hemoglobin level, lymphocyte count, and platelet count (p<0.05). The NLR significantly increased in the group with mortality (p<0.05), while SII and PLR yielded similar results in both groups (p>0.05). In the receiver-operating characteristic curve analysis, the NLR, SII, and PLR areas under the curve for mortality were 0.598, 0.549, and 0.569, respectively.

Conclusion: None of the biomarkers investigated in this study showed an ability to distinguish patients with higher mortality risks. Therefore, these biomarkers may be recommended not as predictive of mortality but as supportive parameters for determining patients’ overall clinical statuses.

Anahtar Kelimeler

Biomarkers, inflammation, intertrochanteric fractures, mortality determinants

İntertrokanterik kırık nedeniyle proksimal femur çivisi uygulanan hastalarda inflamatuar indekslerle mortalitenin ilişkisi

Öz

Amaç: Bu çalışmanın amacı, intertrokanterik femur kırıkları sonrası proksimal femoral çivileme uygulanan geriatrik hastalarda tam kan sayımındaki biyobelirteçlerle mortalite öngörülebilirliğini araştırmaktır.

Yöntem: Osteoporotik intertrokanterik femur kırığı nedeniyle proksimal femoral çivileme uygulanan 247 hasta çalışmamıza dahil edildi. Hastalar iki gruba ayrıldı. Grup A, ameliyat sonrası birinci yılı sağ kalan hastaları (n=162), Grup B ise aynı dönemde ölen hastaları içeriyordu (n=85). Preoperatif demografik bilgiler, ameliyata kadar geçen gün sayısı, C-reaktif protein (CRP), hemoglobin, platelet-lenfosit oranı (PLR), nötrofil-lenfosit oranı (NLR) ve sistemik immün-inflamatuar indeks (SII) incelendi.

Bulgular: Cinsiyet, anestezi türü, lökosit ve nötrofil seviyeleri açısından gruplar arasında istatistiksel olarak anlamlı bir fark bulunmamakla birlikte (p>0.05), yaş, ameliyata kadar geçen gün sayısı, CRP, hemoglobin, lenfosit ve trombosit seviyeleri açısından gruplar arası anlamlı fark bulunmuştur (p<0.05). NLR seviyesi, mortalite gösteren Grup B’de anlamlı olarak yüksek iken (p<0.05), SII ve PLR her iki grupta benzer sonuçlar verdi (p>0.05). ROC analizinde, mortalite için NLR, SII ve PLR için eğri altında kalan alan değerleri sırasıyla 0.598, 0.549 ve 0.569 idi.

Sonuçlar: Bu çalışmada, mortalite riski yüksek olan hastaları ayırt etme imkânı veren bir biyobelirteç bulunamamıştır. Bu nedenle, bu biyobelirteçlerin mortalite öngörülebilirliği için değil de, hastanın genel klinik durumu içinde destekleyici parametreler olarak kullanılabileceği önerilmelidir.

Anahtar Kelimeler

Biyobelirteçler, inflamasyon, intertrokanterik kırıklar, ölüm oranı belirleyicileri

Kaynakça

• Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13.
• Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-33.
• Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019;14(1):203.
• Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV. Risk factors for in-hospital post-hip fracture mortality. Bone. 2011;49(3):553-8.
• Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43(6):676-85.
• Bjørgul K, Reikerås O. Incidence of hip fracture in southeastern Norway: a study of 1,730 cervical and trochanteric fractures. Int Orthop. 2007;31(5):665-9.
• 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):366-71.
• Özbek EA, Ayanoğlu T, Olçar HA, Yalvaç ES. 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):607-12.
• Ozdemir A, Kocak SY, Karabela SN, Yılmaz M. Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?. Nefrologia (Engl Ed). 2022;42(5):549-58.
• Peker B, Senel A. Proximal femoral nail causes lower systemic immunoinflammatory response compared to hemiarthroplasty in the treatment of unstable intertrochanteric fractures. Ann Med Res. 2023;30(1):65-9.
• Wang Z, Wang H, Yang L, Jiang W, Chen X, Liu Y. High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture. Int Orthop. 2021;45(1):13-21.
• Atlas A, Duran E, Pehlivan B, Pehlivan VF, Erol MK, Altay N. The Effect of Increased Neutrophil Lymphocyte Ratio on Mortality in Patients Operated on Due to Hip Fracture. Cureus. 2020;12(1):e6543.
• Bingol O, Ozdemir G, Kulakoglu B, Keskin OH, Korkmaz I, Kilic E. Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures. Injury. 2020;51(11):2663-7.
• 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):71-4.
• Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021;21(1):155.
• Mathur K, Kurbanova N, Qayyum R. Platelet-lymphocyte ratio (PLR) and all-cause mortality in general population: insights from national health and nutrition education survey. Platelets. 2019;30(8):1036-41.
• Balta S, Demirkol S, Unlu M, Arslan Z, Celik T. Neutrophil to lymphocyte ratio may be predict of mortality in all conditions. Br J Cancer. 2013;109(12):3125-6.
• Qin G, He F, Zhang H, et al. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) are more prominent in retinal artery occlusion (RAO) compared to retinal vein occlusion (RVO). PLoS One. 2022;17(2):e0263587.
• He H, Guo W, Song P, et al. Preoperative systemic immune-inflammation index and prognostic nutritional index predict prognosis of patients with pulmonary neuroendocrine tumors after surgical resection. Ann Transl Med. 2020;8(10):630.
• Hou D, Wang C, Luo Y, et al. Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci. 2021;131(12):1203-8.
• Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22.
• Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230.
• Jacob EA. Complete Blood Cell Count and Peripheral Blood Film, Its Significant in Laboratory Medicine: A Review Study. Am J Lab Med. 2016;1(3):34-57.
• Ceyhun HA, Gürbüzer N. New Hematological Parameters as Inflammatory Biomarkers: Systemic Immune Inflammation Index, Platerethritis, and Platelet Distribution Width in Patients with Adult Attention Deficit Hyperactivity Disorder. Adv Neurodev Disord. 2022;6(2):211-23.
• Kang MH, Go SI, Song HN, et al. The prognostic impact of the neutrophil-to-lymphocyte ratio in patients with small-cell lung cancer. Br J Cancer. 2014;111(3):452-60.
• Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107(4):695-699.
• Bala MM. The benefit of dynamic neutrophil-lymphocyte ratio and systemic immune-inflammation index in predicting survival in patients undergoing hemiarthroplasty. Eur Rev Med Pharmacol Sci. 2022;26(11):3878-85.
• 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.
• Yılmaz H, Kazezoğlu C, Gedikbaşı A. The Predictive Value of Systemic Immune Inflammation Index in Patients Hospitalized in the Intensive Care Unit. Med J Bakirkoy. 2022;18:364-9.
• Kristensen TB, Gjertsen JE. Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. Bone Joint J. 2019;101-B(9):1129-37.
• Chen BK, Liu YC, Chen CC, Chen YP, Kuo YJ, Huang SW. Correlation between C-reactive protein and postoperative mortality in patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res. 2023;18(1):182.
• Laulund AS, Lauritzen JB, Duus BR, Mosfeldt M, Jørgensen HL. Routine blood tests as predictors of mortality in hip fracture patients. Injury. 2012;43(7):1014-20.
• Praetorius K, Madsen CM, Abrahamsen B, Jørgensen HL, Lauritzen JB, Laulund AS. Low Levels of Hemoglobin at Admission Are Associated With Increased 30-Day Mortality in Patients With Hip Fracture. Geriatr Orthop Surg Rehabil. 2016;7(3):115-20.
• Varady NH, Yeung CM, Amen TB, Schwab PE, Chen AF. Preoperative Platelet and International Normalized Ratio Thresholds and Risk of Complications After Primary Hip Fracture Surgery. J Am Acad Orthop Surg. 2021;29(8):e396-e403.