Liu Xiao-Yang, Guo Si-Qin, Chen Xu-Ming, Zeng Wei-Nan, Zhou Zong-Ke
Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Orthop Surg. 2025 Aug;17(8):2350-2361. doi: 10.1111/os.70107. Epub 2025 Jul 10.
Given the rising incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures and their substantial impact on mortality and functional recovery, identifying accessible predictors for early risk stratification is critical to improving perioperative management. This study aimed to investigate the association between preoperative inflammation/immune markers and the occurrence of postoperative UTIs in the vulnerable population.
This study examined elderly patients who underwent hip surgery for hip fractures at our institution from March 2014 to June 2024. Preoperative inflammation/immune markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were measured. Receiver operating characteristic (ROC) curves were used to identify optimal cutoff values for each marker. To control the potential confounding factors, multivariate logistic regression analysis and propensity score matching analysis were conducted, resulting in adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the strength of the association between each marker and UTIs.
A total of 1238 patients were included in this study, of whom 287 (23.18%) developed postoperative UTIs. Among elderly hip fracture patients, NLR demonstrated the highest predictive value for postoperative UTIs compared to PLR and SII (area under the curve [AUC] = 0.608, 95% CI: 0.571-0.645). High NLR (OR = 1.57, 95% CI: 1.16-2.13), high PLR (OR = 1.59, 95% CI: 1.16-2.19), and high SII (OR = 1.75, 95% CI: 1.29-2.37) were significantly associated with the incidence of postoperative UTIs using the best cutoff values. Additionally, a dose-effect relationship was observed for this association (p for trend < 0.05). These results remained significant even after propensity score matching.
Preoperative inflammatory/immune markers NLR, PLR, and SII exhibited independent associations with the development of postoperative UTIs in elderly hip fracture patients undergoing surgery. Furthermore, a dose-effect relationship was observed for this association.
鉴于老年髋部骨折患者术后尿路感染（UTI）的发生率不断上升，且其对死亡率和功能恢复有重大影响，确定可用于早期风险分层的预测指标对于改善围手术期管理至关重要。本研究旨在调查术前炎症/免疫标志物与该脆弱人群术后UTI发生之间的关联。
本研究纳入了2014年3月至2024年6月在我院因髋部骨折接受髋部手术的老年患者。测量术前炎症/免疫标志物，如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII）。采用受试者工作特征（ROC）曲线确定每个标志物的最佳临界值。为控制潜在的混杂因素，进行了多因素逻辑回归分析和倾向得分匹配分析，得出调整后的比值比（OR）和95%置信区间（CI），以评估每个标志物与UTI之间关联的强度。
本研究共纳入1238例患者，其中287例（23.18%）发生术后UTI。在老年髋部骨折患者中，与PLR和SII相比，NLR对术后UTI的预测价值最高（曲线下面积[AUC]=0.608，95%CI：0.571-0.645）。使用最佳临界值时，高NLR（OR=1.57，95%CI：1.16-2.13）、高PLR（OR=1.59，95%CI：1.16-2.19）和高SII（OR=1.75，95%CI：1.29-2.37）与术后UTI的发生率显著相关。此外，观察到这种关联存在剂量效应关系（趋势p<0.05）。即使在倾向得分匹配后，这些结果仍然显著。
术前炎症/免疫标志物NLR、PLR和SII与接受手术的老年髋部骨折患者术后UTI的发生存在独立关联。此外，观察到这种关联存在剂量效应关系。
