Pan Wei-Gang, Chou Yu-Ching, Wu Jia-Lin, Yeh Tsu-Te
Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center. No.325, Sec.2, Chenggong Rd., Neihu District, Taipei, 114202, Taiwan, Republic of China.
School of Public Health, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu District, Taipei, 11490, Taiwan.
Eur J Med Res. 2024 Dec 19;29(1):609. doi: 10.1186/s40001-024-02211-w.
Geriatric hip fractures pose a significant health burden, and inflammation may play a role in the short- and long-term prognosis. However, the prognostic significance of hematologic inflammatory markers in geriatric patients with fractures is not understood. The aim of this systematic review and meta-analysis was to assess the prognostic implications of systemic inflammatory markers on the long-term mortality of older patients with hip fractures.
PubMed, EMBASE, and Cochrane CENTRAL were searched from inception to December 19, 2023. Prospective, retrospective cohort, and case-control studies investigating the prognostic impact of hematologic inflammatory markers on mortality after hip fracture were eligible. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated to determine the associations between the markers and mortality risk, with heterogeneity assessed by I statistic. The quality of the studies was appraised using the Newcastle-Ottawa Scale.
Ultimately, 7 retrospective studies involving a total of 7212 patients were included. The meta-analysis revealed that the neutrophil-to-lymphocyte ratio (NLR) (HR = 1.04, 95% CI 1.02-1.08), systemic immune-inflammatory index (SII) (HR = 1.03, 95% CI 1.01-1.05), and red cell distribution width (RDW) (HR = 1.07, 95% CI 1.01-1.14) independently correlated with increased long-term mortality.
Elevated NLR, SII, and RDW are independently associated with increased long-term mortality in older patients with hip fractures. These findings imply the potential value of incorporating these inflammatory indicators to aid in prognostic stratification of geriatric patients with hip fractures.
老年髋部骨折带来了沉重的健康负担，炎症可能在短期和长期预后中发挥作用。然而，血液学炎症标志物在老年骨折患者中的预后意义尚不清楚。本系统评价和荟萃分析的目的是评估全身炎症标志物对老年髋部骨折患者长期死亡率的预后影响。
检索了从数据库建库至2023年12月19日的PubMed、EMBASE和Cochrane CENTRAL数据库。纳入前瞻性、回顾性队列研究以及病例对照研究，这些研究需探讨血液学炎症标志物对髋部骨折后死亡率的预后影响。计算合并风险比（HR）及相应的95%置信区间（CI），以确定标志物与死亡风险之间的关联，并用I统计量评估异质性。采用纽卡斯尔-渥太华量表对研究质量进行评价。
最终纳入了7项回顾性研究，共涉及7212例患者。荟萃分析显示，中性粒细胞与淋巴细胞比值（NLR）（HR = 1.04，95%CI 1.02 - 1.08）、全身免疫炎症指数（SII）（HR = 1.03，95%CI 1.01 - 1.05）和红细胞分布宽度（RDW）（HR = 1.07，95%CI 1.01 - 1.14）与长期死亡率增加独立相关。
NLR、SII和RDW升高与老年髋部骨折患者长期死亡率增加独立相关。这些发现提示纳入这些炎症指标有助于对老年髋部骨折患者进行预后分层的潜在价值。
