Temiz Aytun, Ersözlü Salim
Department of Orthopedics and Traumatology, Balıkesir Edremit State Hospital, Balıkesir-Turkey.
Ulus Travma Acil Cerrahi Derg. 2019 Jan;25(1):71-74. doi: 10.5505/tjtes.2018.94572.
Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that the neutrophil-to-lymphocyte ratio (NLR), which is a laboratory marker used to evaluate systemic inflammation, may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission NLR in elderly patients with hip fracture.
We evaluated patients admitted to the Orthopaedic Surgery Department of Balikesir-Edremit State Hospital. Inclusion criteria were female gender, age between 65 and 80 years, ASA score of 3, unstable intertrochanteric fracture treated with hemiarthroplasty, and time between fracture and surgery less than 72 h. Patients with multiple fracture, previous same side or other side hip surgery, pathological fracture, such as fracture caused by tumor or metabolic bone disease (e.g., Paget's disease), and malignancies were excluded from this study (purposive sampling technique). Finally, "case" (group 1) was defined as patients who died within 1 year after surgery, whereas "control" (group 2) was defined as patients who survived. Patients in group 1 and 2 were statistically compared in terms of NLR value on hospital admission. A total of 22 patients (44%) were included in group 1, and 28 (56%) were included in group 2.
We found that the admission NLR values of patients in the mortality group were significantly higher than those of patients in the control group (p<0.001). The cutoff value of NLR was calculated as 4.7 on ROC analysis.
We believe that the NLR value at admission could be used for risk stratification of mortality in elderly patients with hip fracture.
老年患者髋部骨折与高死亡率相关。大多数与髋部骨折相关的死亡是由手术后的并发症导致的。最近的研究表明，中性粒细胞与淋巴细胞比值（NLR）作为一种用于评估全身炎症的实验室指标，可能有助于估计额外死亡率。本研究旨在探讨入院时NLR对老年髋部骨折患者的预后价值。
我们评估了巴勒克埃西尔-埃迪尔内州立医院骨科收治的患者。纳入标准为女性，年龄在65至80岁之间，美国麻醉医师协会（ASA）评分为3分，采用半髋关节置换术治疗的不稳定型转子间骨折，骨折与手术之间的时间少于72小时。本研究排除了多发骨折、既往同侧或对侧髋部手术史、病理性骨折（如由肿瘤或代谢性骨病，如佩吉特病引起的骨折）以及恶性肿瘤患者（采用目的抽样技术）。最后，“病例组”（第1组）定义为术后1年内死亡的患者，而“对照组”（第2组）定义为存活患者。对第1组和第2组患者入院时的NLR值进行统计学比较。第1组共纳入22例患者（44%），第2组纳入28例患者（56%）。
我们发现死亡组患者入院时的NLR值显著高于对照组患者（p<0.001）。在ROC分析中，NLR的截断值计算为4.7。
我们认为入院时的NLR值可用于老年髋部骨折患者死亡风险分层。
