NLR as a Prognostic Tool in Orthopaedic Surgery in Elderly Extra-Articular Hip Fracture: A Significant Increase in NLR 24 Hours after Surgical Intervention

Abstract

Neutrophil-to-lymphocyte ratio (NLR) was developed as a diagnostic and prognostic tool in many medical conditions, and its use is spreading as a predictor of postoperative outcome in orthopaedic surgery. The aim of this study is to investigate the improvement of NLR 24 hours after surgical intervention in a cohort of 91 patients (F/M = 68/23) with hip fracture who underwent femur intramedullary fixation. Patients were 84.7 ± 7.9 years old, and the mean hospital stay was 13.4 ± 4.7 days, with a mean delay to surgery of 1.9 ± 1.4 days. A significant increase in NLR between baseline (T0) and 24 hours after surgical intervention (T1) was observed in the study sample overall and on subgroup analysis by gender. Nevertheless, no significant effect of NLR on the length of hospital stay was observed.

Keywords

neutrophil-to-lymphocyte ratio - trochanteric region fracture - intramedullary nail

Authors' Contributions

L.T., S.P., and L.V. had the idea of the study and prepared the first version of the manuscript. L.T., S.P., and L.D.L. retrieved data and prepared the dataset. L.T. run the data analyses and, together with S.P., L.V., and C.L.V., wrote this article, setting up the English version of the manuscript, tables and figures, and their final version. G.M. and A.P. G. collaborated to the final version of the manuscript, with some advises as mentors. L.V. and C.L.V. critically revised the manuscript giving their useful suggestions.

Publikationsverlauf

Eingereicht: 01. Februar 2022

Angenommen: 13. Juli 2022

Artikel online veröffentlicht:
08. September 2022

• References

• 1 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 (01) 183
• 2 Ergin ÖN, Bayram S, Anarat FB, Yağcı TF, Balcı Hİ. Prognostic factors affecting survival of patients with intertrochanteric femoral fractures over 90 years treated with proximal femoral nailing. Eur J Trauma Emerg Surg 2020; 46 (03) 663-669
• 3 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 (08) 588-602
• 4 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 (01) 71-74
• 5 He R, Wang F, Shen H, Zeng Y, Zhang L. Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture. BMC Psychiatry 2020; 20 (01) 496
• 6 Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014; 43 (04) 464-471
• 7 Kukla C, Heinz T, Gaebler C, Heinze G, Vécsei V. The standard Gamma nail: a critical analysis of 1,000 cases. J Trauma 2001; 51 (01) 77-83
• 8 Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 1991; 73 (02) 330-334
• 9 Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br 1993; 75 (05) 789-793
• 10 Hao Z, Wang X, Zhang X. Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: a network meta-analysis. J Orthop Surg Res 2018; 13 (01) 157
• 11 Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma 2018; 32 (Suppl. 01) S1-S170
• 12 Halm EA, Wang JJ, Boockvar K. et al. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma 2004; 18 (06) 369-374
• 13 Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma 2002; 16 (01) 39-44
• 14 O'Daly BJ, Walsh JC, Quinlan JF. et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr 2010; 29 (01) 89-93
• 15 Pimlott BJ, Jones CA, Beaupre LA, Johnston DWC, Majumdar SR. Prognostic impact of pre-operative albumin on short-term mortality and complications in patients with hip fracture. Arch Gerontol Geriatr 2011; 53 (01) 90-94
• 16 Lewis JR, Hassan SKZ, Wenn RT, Moran CG. Mortality and serum urea and electrolytes on admission for hip fracture patients. Injury 2006; 37 (08) 698-704
• 17 Mosfeldt M, Pedersen OB, Riis T. et al. Value of routine blood tests for prediction of mortality risk in hip fracture patients. Acta Orthop 2012; 83 (01) 31-35
• 18 Ivars Rubio A, Yufera JC, de la Morena P. et al. Neutrophil-lymphocyte ratio in metastatic breast cancer is not an independent predictor of survival, but depends on other variables. Sci Rep 2019; 9 (01) 16979
• 19 Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ. The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review. J Surg Oncol 2017; 115 (04) 470-479
• 20 Bhat T, Teli S, Rijal J. et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013; 11 (01) 55-59
• 21 Angkananard T, Anothaisintawee T, McEvoy M, Attia J, Thakkinstian A. Neutrophil lymphocyte ratio and cardiovascular disease risk: a systematic review and meta-analysis. BioMed Res Int 2018; 2018: 2703518
• 22 Van de Ree CLP, Landers MJF, Kruithof N. et al. Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study. BMJ Open 2019; 9 (07) e025941
• 23 Dayama A, Olorunfemi O, Greenbaum S, Stone Jr ME, McNelis J. Impact of frailty on outcomes in geriatric femoral neck fracture management: an analysis of national surgical quality improvement program dataset. Int J Surg 2016; 28: 185-190
• 24 Kistler EA, Nicholas JA, Kates SL, Friedman SM. Frailty and short-term outcomes in patients with hip fracture. Geriatr Orthop Surg Rehabil 2015; 6 (03) 209-214
• 25 Chen C-L, Chen C-M, Wang C-Y. et al. Frailty is associated with an increased risk of major adverse outcomes in elderly patients following surgical treatment of hip fracture. Sci Rep 2019; 9 (01) 19135
• 26 Shen Y, Hao Q, Wang Y. et al. The association between preoperative modified frailty index and postoperative complications in Chinese elderly patients with hip fractures. BMC Geriatr 2021; 21 (01) 370
• 27 Borgström F, Karlsson L, Ortsäter G. et al. International Osteoporosis Foundation. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos 2020; 15 (01) 59
• 28 Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med 2017; 377 (21) 2053-2062
• 29 Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2010; (09) CD000093
• 30 Raaymakers E, Schipper I, Rogier S, van der Werken C. Proximal femur [Internet]. AO Surgery Reference. Accessed on May 20, 2022, at: https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur