Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio
Background: The assessment and identification of elderly patients with proximal femur fractures (PFF) who are at high risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) could...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/2/456 |
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| author | Omer Marom Inbar Paz David Segal Guy Topaz Nitzan Abelson Alex Tavdi Refael Behrbalk Ezequiel Palmanovich Nissim Ohana Eyal Yaacobi |
| author_facet | Omer Marom Inbar Paz David Segal Guy Topaz Nitzan Abelson Alex Tavdi Refael Behrbalk Ezequiel Palmanovich Nissim Ohana Eyal Yaacobi |
| author_sort | Omer Marom |
| collection | DOAJ |
| description | Background: The assessment and identification of elderly patients with proximal femur fractures (PFF) who are at high risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to predict postoperative mortality in the elderly population. Methods: A four-year retrospective cohort study of electronic medical records was conducted at a single tertiary care hospital between 2015 and 2018. Data from 1551 patients aged 65 years and older who underwent surgical treatment for PFF were collected and analyzed. The data included complete blood counts at admission, demographic information, underlying illnesses, type of surgery, and postoperative mortality and complications during the first year of follow-up. A survival analysis model was utilized. Results: The mean age was 90.76 ± 1.88 years, 1066 (68.7%) women. Forty-four (2.8%) patients experienced postoperative infection. A higher NLR<sub>0</sub> was independently associated with higher all-cause mortality rates in patients who underwent surgical treatment for PFF (<i>p</i> = 0.041). Moreover, the mean NLR<sub>0</sub> value was higher when the death occurred earlier after surgery (<i>p</i> < 0.001). Conclusions: When combined with other clinical and laboratory findings, NLR<sub>0</sub> levels may serve as a potentially valuable, inexpensive, and reliable prognostic biomarker to improve risk stratification for elderly patients who are candidates for PFF surgery. Furthermore, with additional research, we could potentially develop a treatment algorithm to identify patients at high risk of postoperative mortality. |
| first_indexed | 2024-03-09T12:12:27Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T12:12:27Z |
| publishDate | 2023-01-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1dd037162c244b4693c29ceece2971ee2023-11-30T22:50:12ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112245610.3390/jcm12020456Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte RatioOmer Marom0Inbar Paz1David Segal2Guy Topaz3Nitzan Abelson4Alex Tavdi5Refael Behrbalk6Ezequiel Palmanovich7Nissim Ohana8Eyal Yaacobi9Orthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelOrthopedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, IsraelBackground: The assessment and identification of elderly patients with proximal femur fractures (PFF) who are at high risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to predict postoperative mortality in the elderly population. Methods: A four-year retrospective cohort study of electronic medical records was conducted at a single tertiary care hospital between 2015 and 2018. Data from 1551 patients aged 65 years and older who underwent surgical treatment for PFF were collected and analyzed. The data included complete blood counts at admission, demographic information, underlying illnesses, type of surgery, and postoperative mortality and complications during the first year of follow-up. A survival analysis model was utilized. Results: The mean age was 90.76 ± 1.88 years, 1066 (68.7%) women. Forty-four (2.8%) patients experienced postoperative infection. A higher NLR<sub>0</sub> was independently associated with higher all-cause mortality rates in patients who underwent surgical treatment for PFF (<i>p</i> = 0.041). Moreover, the mean NLR<sub>0</sub> value was higher when the death occurred earlier after surgery (<i>p</i> < 0.001). Conclusions: When combined with other clinical and laboratory findings, NLR<sub>0</sub> levels may serve as a potentially valuable, inexpensive, and reliable prognostic biomarker to improve risk stratification for elderly patients who are candidates for PFF surgery. Furthermore, with additional research, we could potentially develop a treatment algorithm to identify patients at high risk of postoperative mortality.https://www.mdpi.com/2077-0383/12/2/456comorbidityfemurfracturemortalityneutrophil-to-lymphocyte ratio |
| spellingShingle | Omer Marom Inbar Paz David Segal Guy Topaz Nitzan Abelson Alex Tavdi Refael Behrbalk Ezequiel Palmanovich Nissim Ohana Eyal Yaacobi Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio Journal of Clinical Medicine comorbidity femur fracture mortality neutrophil-to-lymphocyte ratio |
| title | Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio |
| title_full | Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio |
| title_fullStr | Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio |
| title_full_unstemmed | Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio |
| title_short | Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio |
| title_sort | proximal femur fractures in the elderly a novel modality to predict mortality the neutrophil to lymphocyte ratio |
| topic | comorbidity femur fracture mortality neutrophil-to-lymphocyte ratio |
| url | https://www.mdpi.com/2077-0383/12/2/456 |
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