Mustafa YERLİ, Ali YÜCE, Hakan GÜRBÜZ, Niyazi İĞDE, Mustafa Buğra AYAZ

The role of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, crp and albumin to predict postoperative one-year mortality in patients with hip fractures

Elderly patients are espcialy at high risk for postoperative complications. This is even more important following hip fracture surgery due to its fragility and comorbidities. Using certain biomarkers may be an interesting way of tackling the question of optimal patient management. In this study we aimed to determine the status of values such as NLR, PLR, albumin, and CRP, which can be easily accessed from blood tests that we routinely use, in predicting mortality in patients who underwent partial prosthesis after hip fractures. Patients over 70 years of age with intertrochanteric femur and collum femoris fractures and who underwent partial endoprosthesis were included in the study. The neutrophil lymphocyte and platelet lymphocyte ratios, albumin values, and CRP values were recorded by examining the hemogram and biochemistry tests taken routinely at the time of admission to the hospital, 1 day before the surgery and on the 1st post-operative day. The distribution of clinical and socio-demographic characteristics of individuals according to their survival within the scope of the study has elaborated that there is a statistically significant difference in terms of age, gender, diagnosis, time to surgery (days) of the deceased and surviving individuals. It is observed that the majority of the patients who died were women and were diagnosed with collum femoris. It was determined that there was a statistically significant difference only in CRP and albumin values between the two groups in postoperative parameters. According to the outcomes of this analysis one can conclude that NLR and PLR values measured preoperatively on the hemogram panel can be used to predict 1-year mortality. Regardless of the fracture period, low albumin value is seen as an independent variable in predicting mortality

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1. Tajeu GS, Delzell E, Smith W, et al. Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci. 2014;69:346–53.
2. Boddaert J, Na N, Le Manach Y, et al. Prediction of postoperative mortality in elderly patients with hip fracture: are specific and geriatric scores better than general scores? Br J Anaesth. 2017;118:952–4.
3. Forget P, Dillien P, Engel H, et al. 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;9:284.
4. Wang X, Zhao BJ, Su Y. Can we predict postoperative complications in elderly Chinese patients with hip fractures using the surgical risk calculator? Clin Interv Aging. 2017;12:1515–20.
5. Hommel A, Ulander K, Bjorkelund KB, et al. Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury. 2008;39:1164–74.
6. Smith T, Pelpola K, Ball M, et al. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43:464–71.
7. Ishida Y, Kawai S, Taguchi T. Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures. Clin Orthop Relat Res. 2005;436:208–15.
8. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture: national analysis of comedications, comorbidity and survival. Age Ageing. 2010;39:203–9.
9. Forget P, Moreau N, Engel H, et al. The postoperative neutrophil-tolymphocyte ratio (NLR) is an important risk factor of worse outcome and mortality after surgery for hip fracture. Arch Gerontol Geriatr. 2014;0167– 4943:00220–9.
10. Meessen JM, Pisani S, Gambino ML, et al. Assessment of mortality risk in elderly patients after proximal femoral fracture. Orthopedics. 2014;37:194– 200.
11. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-tolymphocyte ratio in predicting shortand long-term mortality in breast cancer patients. Ann Surg Oncol. 2012;19:217–24.
12. Malietzis G, Giacometti M, Askari A, et al. A preoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery. Ann Surg. 2014;260:287–92.
13. Shimada H, Takiguchi N, Kainuma O, et al. High preoperative neutrophillymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13:170–6.
14. Sevimli R, Aslanturk O, Ertem K, et al. An investigation of infection rate and seasonal effect level in total joint replacement cases. Med Sci. 2018;7:210-3.
15. Pande I, Scott DL, O’Neill TW, et al. Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis. 2006;65:87-92.
16. Brossa Torruella A, Tobias Ferrer J, Zorrilla Ribeiro J, et al. Mortality after hip fracture: a three year follow-up study. [Article in Spanish] Med Clin (Barc). 2005;124:53.
17. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.
18. McLeod K, Brodie MP, Fahey PP, Gray RA. Long-term survival of surgically treated hip fracture in an Australian regional hospital. Anaesth Intensive Care. 2005;33:749-55.
19. Franzo A, Francescutti C, Simon G. Risk factors correlated with postoperative mortality for hip fracture surgery in the elderly: a populationbased approach. Eur J Epidemiol. 2005;20:985-91.
20. Byung-Gun Kim, Young-Kyun Lee, Hee-Pyoung Park, et al. C-reactive protein is an independent predictor for 1-year mortality in elderly patients undergoing hip fracture surgery: A retrospective analysis. Medicine, 2016;95.
21. Johannes K M Fakler, Antonia Grafe, Jamila Dinger, et al. Perioperative risk factors in patients with a femoral neck fracture–influence of 25-hydroxyvitamin D and C-reactive protein on postoperative medical complications and 1-year mortality. BMC Musculoskeletal Disorders, 2016;17:51.
22. 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 Anesthesiology, 2018;18:183.
23. Daniel D Bohl, Mary R Shen, Charles P Hannon, et al. Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. JBJS. 2017;99:2110-8.
24. S J Harrison, J Messner, D J Leeder, et al. Are albumin levels a good predictor of mortality in elderly patients with neck of femur fractures? J Nutrition. Health Aging. 2017;21:699-703.
25. Sultan Aldebeyan, Anas Nooh, Ahmed Aoude, et al. Hypoalbuminaemia—a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. Injury. 2017;48:436-40.
26. Bryan J Pimlott, C Allyson Jones, Lauren A Beaupre, et al. Prognostic impact of pre-operative albumin on short-term mortality and complications in patients with hip fracture. Archives of gerontology and geriatrics, 2011;53:90-4.
27. Miyanishi K, Jingushi S, Torisu T. Mortality after hip fracture in Japan: the role of nutritional status. J Orthop Surg. 2010;18:265-70.
28. Dokmeci MO, Kalender AM, Sevimli R, et al. The Effect of Ibandronate on Fracture Healing in Rat Tibia Model. SM J Orthop. 2016;2:1041.
29. 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.
30. Zhicong Wang, Hong Wang, Ling Yang, et al. High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture, Int Orthop. 2021;45:13-21.