Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Xiaogan, Hubei, China.
Front Immunol. 2023 Aug 9;14:1223464. doi: 10.3389/fimmu.2023.1223464. eCollection 2023.
This study aimed to investigate the association between the neutrophil percentage to albumin ratio (NPAR) on the day of admission and mortality 1 year after surgery in elderly patients with hip fractures.
Clinical characteristics and blood markers of inflammation were retrospectively collected from October 2016 to January 2022 in elderly patients with hip fractures at two different regional tertiary medical centers. It is divided into a training set and an external validation set. Multivariate Nomogram models such as NPAR were constructed using the least absolute shrinkage and selection operator (LASSO) regression results and multi-factor logistic regression analysis. In addition, multivariate Cox regression analysis and Kaplan-Meier survival curves were used to explore the relationship between NPAR values and mortality within 1 year in elderly patients with hip fractures. The predictive performance of the Nomogram was evaluated using the concordance index (C Index) and receiver operating characteristic curve (ROC) and validated by Bootstrap, Hosmer-Lemesow goodness of fit test, calibration curve, decision curve, and clinical impact curve analysis.
The study included data from 1179 (mean age, 80.34 ± 8.06 years; 61.4[52.1%] male) patients from the Guangzhou Red Cross Hospital affiliated with Jinan University and 476 (mean age, 81.18 ± 8.33 years; 233 [48.9%] male) patients from the Xiaogan Central Hospital affiliated with Wuhan University of Science and Technology. The results showed that NPAR has good sensitivity and specificity in assessing patients' prognosis 1 year after surgery. Multivariate logistic regression models based on influencing factors such as NPAR have good discrimination and calibration ability (AUC=0.942, 95% CI:0.927-0.955; Hosmer-Lemeshow test: P >0.05). Kaplan-Meier survival curves for the training and validation sets showed that patients in the high NPAR group had a higher mortality rate at 1 year compared to the low NPAR group (P< 0.001). Multivariate Cox regression showed that high NPAR values were an independent risk factor for death within 1 year in elderly hip fracture patients (P< 0.001, HR =2.38,95%CI:1.84-3.08).
Our study showed that NPAR levels were significantly higher in patients who died within 1 year after surgery in both the training and validation sets. NPAR has good clinical value in assessing 1-year postoperative prognosis in elderly patients with hip fractures.
本研究旨在探讨入院时中性粒细胞百分比与白蛋白比值（NPAR）与老年髋部骨折患者术后 1 年死亡率之间的关系。
回顾性收集 2016 年 10 月至 2022 年 1 月期间来自两个不同地区三级医疗中心的老年髋部骨折患者的临床特征和炎症血液标志物。将其分为训练集和外部验证集。使用最小绝对收缩和选择算子（LASSO）回归结果和多因素逻辑回归分析构建 NPAR 等多变量列线图模型。此外，使用多因素 Cox 回归分析和 Kaplan-Meier 生存曲线探讨 NPAR 值与老年髋部骨折患者 1 年内死亡率之间的关系。通过一致性指数（C 指数）和接受者操作特征曲线（ROC）评估列线图的预测性能，并通过 Bootstrap、Hosmer-Lemesow 拟合优度检验、校准曲线、决策曲线和临床影响曲线分析进行验证。
本研究纳入了来自暨南大学附属广州红十字会医院的 1179 名（平均年龄 80.34±8.06 岁；61.4%[52.1%]为男性）患者和来自武汉大学附属孝感市中心医院的 476 名（平均年龄 81.18±8.33 岁；233[48.9%]为男性）患者的数据。结果表明，NPAR 在评估患者术后 1 年的预后方面具有良好的灵敏度和特异性。基于 NPAR 等影响因素的多因素逻辑回归模型具有良好的区分度和校准能力（AUC=0.942，95%CI：0.927-0.955；Hosmer-Lemeshow 检验：P>0.05）。训练集和验证集的 Kaplan-Meier 生存曲线表明，高 NPAR 组患者在 1 年内的死亡率高于低 NPAR 组（P<0.001）。多因素 Cox 回归表明，高 NPAR 值是老年髋部骨折患者 1 年内死亡的独立危险因素（P<0.001，HR=2.38，95%CI：1.84-3.08）。
本研究表明，在训练集和验证集中，术后 1 年内死亡的患者的 NPAR 水平均显著升高。NPAR 在评估老年髋部骨折患者术后 1 年预后方面具有良好的临床价值。
