The effect of neutrophil-lymphocyte ratio on admission to postoperative intensive care and mortality in elderly patients undergoing hip fracture surgery with spinal anesthesia

Yıl 2021, Cilt: 7 Sayı: 6, 628 - 634, 04.11.2021

Ökkeş Hakan Miniksar , Osman Kaçmaz

https://doi.org/10.18621/eurj.835339

Cited By: 2

Öz

Objectives: Hip Fractures (HF) affect the elderly in particular, and are associated with high mortality rates. Most geriatric patients are admitted to Intensive Care Unit (ICU) after HF surgery. In this study, the purpose was to investigate the prognostic value of preoperative NLR (Neutrophil-to-Lymphocyte Ratio) on postoperative ICU admission and mortality in elderly patients with HF.

Methods: In the present study, the data of 188 geriatric patients who underwent surgery because of isolated HF (i.e. femur neck and intertrochanteric fracture) were examined retrospectively. The patients over 65 years of age, ASA score 3/4, whose preoperative duration was less than 72 hours, and who underwent spinal anesthesia were included in the study. The patients were divided into two groups as ICU admission (ICU, n = 58), and Non-ICU (Non-ICU, n = 130). The patients were also grouped as Survival (n = 168) and Non-survival (n = 20) according to postoperative mortality rates. NLR values were statistically compared between the groups.

Results: The preoperative NLR values of the patients in the ICU Group were significantly higher than those in the Non-ICU Group (p < 0.001). The cut-off value of NLR for ICU admission was found to be 9.65 with 89% sensitivity and 67% specificity in the ROC analysis. The median NLR value was 6.42 (3.55-9.44) in the Survivor Group, and 9.5 (7.23-11.02) in the Non-Survivor Groups (p = 0.015).

Conclusions: It was shown in the study that high NLR values in elderly patients may be a risk factor for ICU admission, and for postoperative mortality after HF.

Anahtar Kelimeler

Geriatrics, hip fracture, neutrophil-to-lymphocyte ratio, intensive care unit, mortality

Kaynakça

• 1. Temiz A, Ersözlü S. Admission neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture. J Trauma Acute Care Surg 2019;25:71-4.
• 2. Barbosa TA, Souza AMF, Leme FCO, Grassi LDV, Cintra FB, Lima RM, et al. [Perioperative complications and mortality in elderly patients following surgery for femoral fracture: prospective observational study]. Brazilian J Anesthesiol 2019;69:569-79. [Article in Portuguese]
• 3. 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;43:676-85.
• 4. Onwochei DN, Fabes J, Walker D, Kumar G, Moonesinghe SR. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia 2020;75(S1):e62-74.
• 5. Zeyneloğlu P, Pirat A, Candan S, Canikli Ş. Predictors of intensive care unit admission in geriatric patients undergoing hip replacement. J Turk Soc Intens Care 2006;6:108-11.
• 6. Jang IY, Lee YS, Jung HW, Chang JS, Kim JJ, Kim HJ, et al. Clinical outcomes of perioperative geriatric intervention in the elderly undergoing hip fracture surgery. Ann Geriatr Med Res 2016;20:125-30.
• 7. Mosfeldt M, Pedersen OB, Riis T, Worm HO, Mark S Van Der, Jørgensen HL, et al. Value of routine blood tests for prediction of mortality risk in hip fracture patients. Acta Orthop 2012;83:31-5.
• 8. Forget P, Dillien P, Engel H, Cornu O, De Kock M, Yombi JC. Use of the neutrophil-to-lymphocyte ratio as a component of a score to predict postoperative mortality after surgery for hip fracture in elderly subjects. BMC Res Notes 2016;9:1-6.
• 9. 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? Turk Assoc Trauma Emerg Surg 2020;26:607-12.
• 10. 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;13:588-602.
• 11. Keel M, Trentz O. Pathophysiology of polytrauma. Injury 2005;36:691-709.
• 12. Kaplan C, Araz C, Candan S, Pirat A, Zeyneloğlu P, Ayhan A, et al. Predictors of intensive care unit admission following cytoreductive surgery for Stage III-IV ovarian carcinoma. J Turk Soc Intens Care 2012;8:102-9.
• 13. Sun T, Wang X, Liu Z, Chen X, Zhang J. Plasma concentrations of pro- and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients. Injury 2011;42:707-13.
• 14. Niessen R, Bihin B, Gourdin M, Yombi JC, Cornu O, Forget P. Prediction of postoperative mortality in elderly patient with hip fractures: a single-centre, retrospective cohort study. BMC Anesthesiol 2018;18:5-7.
• 15. Dilektasli E, Inaba K, Haltmeier T, Wong MD, Clark D, Benjamin ER, et al. The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg 2016;81:882-8.
• 16. Vaughan-Shaw PG, Rees JRE, King AT. Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly. Int J Surg 2012;10:157-62.
• 17. Emektar E, Corbacioglu SK, Dagar S, Uzunosmanoglu H, Safak T, Cevik Y. 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;16:165-70.
• 18. Aslan A, Atay T, Aydoğan NH. Risk factors for mortality and survival rates in elderly patients undergoing hemi arthroplasty for hip fracture. Orthop Traumatol Turc 2020;54:138-43.
• 19. Akbas S, Ozkan A. Regional versus general anesthesia in patients underwent hip fracture surgery over 80 years old: a retrospective cohort study. Ann Med Res 2018;25:698.
• 20. Daşar U. One-year retrospective evaluation of hip fracture patients aged more than 80 years and postoperatively monitored in the intensive care unit. Turk Geriatr Derg 2018;21:81-6.
• 21. Anthony CA, Duchman KR, Bedard NA, Gholson JJ, Gao Y, Pugely AJ, et al. Hip fractures: appropriate timing to operative intervention. J Arthroplasty 2017;32:3314-8.
• 22. Kayrak M, Erdoǧan HI, Solak Y, Akilli H, Gül EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Hear Lung Circ 2014;23:56-62.
• 23. Bruunsgaard H, Pedersen M, Pedersen BK. Aging and proinflammatory cytokines. Curr Opin Hematol 2001;8:131-6.
• 24. Karahan MA. The effect of spinal anesthetic technique on neutrophil to lymphocyte ratio and postoperative mortality in elderly patients with coronary artery disease undergoing hip replacement surgery. Turk Geriatr Derg 2019;22:305-14.
• 25. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther 2016;14:573-7.