Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score
Yıl: 2022 Cilt: 33 Sayı: 3 Sayfa Aralığı: 538 - 546 Metin Dili: İngilizce DOI: 10.52312/jdrs.2022.683 İndeks Tarihi: 29-05-2023
Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score
Öz: Objectives: In this study, we aimed to compare the neutrophil-to- lymphocyte ratio (NLR), red blood cell distribution width (RDW), and Nottingham Hip Fracture Score (NHFS) according to one-year mortality estimation after hip fracture surgery in elderly. Patients and methods: Between January 2015 and December 2019, a total of 190 elderly patients (63 males, 127 females; mean age: 82.8±6.1 years; range, 70 to 98 years) who were diagnosed with collum femoris fractures treated with hemiarthroplasty were included. The cohort was divided into two groups with NHFS ≤4 and >4 as the low- and high-risk patients, respectively and one-year mortality was assessed for both groups. The RDW was evaluated with blood values sampled on the day of admission. A cut-off of 14.5% was considered for the RDW values. The NLR values calculated on admission (NLR-D0) and postoperative Day 5 (NLR-D5) were considered the primary outcome measures. Results: A total of 46 patients (24.2%) developed any type of complication. The NLR values higher than 5 on Days 0 and 5 were more frequently seen in the complicated patients (p=0.0016 and p<0.001). There were significantly more patients with higher RDW values (>14.5%) in the complicated group (p<0.001). The median NHFS and the rate of patients with NHFS >4 were significantly higher in the complicated patients (p<0.001 for both). The NHFS value higher than 4 had a sensitivity of 87.7% and specificity of 84.0% in predicting mortality (area under the curve [AUC]=0.910, 95% confidence interval [CI]: 0.860-0.947, p<0.001). Estimation of mortality using an RDW cut-off value of >14.5 showed 87.7% and 80.0% sensitivity and specificity, respectively (95% CI: 0.789-0.904, p<0.001). The AUC of the NLR Day 5 using a cut-off value of >6.8 was 0.953 for the prediction of mortality (95% CI: 0.912-0.978, p<0.001). Conclusion: Age, NLR Day 5 (>5), RDW (>14.5%) and NHFS (>4) were strongly associated with mortality prediction. The NHSF and RDW values had the highest and similar sensitivity merit, while the highest specificity was in NLR-D5. Therefore, NLR, RDW and NHFS values can be used to classify risk factors in estimating one-year mortality rates in elderly patients operated for hip fractures. A multidisciplinary approach should be standardized in determining the risk factors before treatment in patients with hip fractures and in planning appropriate treatment for this risk.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Lee J, Shin KY, Nam HW, Oh M, Shim GS. Mortality rates of hip fracture patients with non-operative treatment. Jt Dis Relat Surg 2022;33:17-23.
- 2. Sezgin EA, Tor AT, Markevičiūtė V, Širka A, Tarasevičius Š, Raina DB, et al. A combined fracture and mortality risk index useful for treatment stratification in hip fragility fractures. Jt Dis Relat Surg 2021;32:583-9.
- 3. Guo D, Han A, Jing W, Chen D, Jin F, Li M, et al. Preoperative to postoperative change in neutrophil-to-lymphocyte ratio predict survival in colorectal cancer patients. Future Oncol 2018;14:1187-96.
- 4. Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T, et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis 2015;18:731-5.
- 5. Bingol O, Ozdemir G, Kulakoglu B, Keskin OH, Korkmaz I, Kilic E. Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures. Injury 2020;51:2663-7.
- 6. Özbek EA, Ayanoğlu T, Olçar HA, Yalvaç ES. Is the preoperative neutrophil-to-lymphocyte ratio a predictive value for postoperative mortality in orthogeriatric patients who underwent proximal femoral nail surgery for pertrochanteric fractures? Ulus Travma Acil Cerrahi Derg 2020;26:607-12.
- 7. Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009;169:515-23.
- 8. Osadnik T, Strzelczyk J, Hawranek M, Lekston A, Wasilewski J, Kurek A, et al. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovasc Disord 2013;13:113.
- 9. Kim KM, Lui LY, Cauley JA, Ensrud KE, Orwoll ES, Schousboe JT, et al. Red cell distribution width is a risk factor for hip fracture in elderly men without anemia. J Bone Miner Res 2020;35:869-74.
- 10. Sakai Y, Wakao N, Matsui H, Watanabe T, Iida H, Katsumi A. Elevated red blood cell distribution width is associated with poor outcome in osteoporotic vertebral fracture. J Bone Miner Metab 2021;39:1048-57.
- 11. Kim KM, Lui LY, Cauley JA, Ensrud KE, Orwoll ES, Schousboe JT, et al. Red cell distribution width is a risk factor for hip fracture in elderly men without anemia. J Bone Miner Res 2020;35:869-74.
- 12. Zehir S, Sipahioğlu S, Ozdemir G, Sahin E, Yar U, Akgül T. Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis. Acta Orthop Traumatol Turc 2014;48:141-6.
- 13. Yin P, Lv H, Li Y, Meng Y, Zhang L, Zhang L, et al. Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all- cause mortality: A prospective study with 2-year follow-up. Osteoporos Int 2018;29:1559-67.
- 14. Marom O, Paz I, Topaz G, Ohana N, Yaacobi E. Red cell distribution width-A mortality predictor in older adults with proximal femoral fracture. Arch Gerontol Geriatr 2022;100:104623.
- 15. Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 2005;20:494-500.
- 16. van Zeeland ML, Genovesi IP, Mulder JW, Strating PR, Glas AS, Engel AF. POSSUM predicts hospital mortality and long-term survival in patients with hip fractures. J Trauma 2011;70:E67-72.
- 17. Rushton PR, Reed MR, Pratt RK. Independent validation of the Nottingham Hip Fracture Score and identification of regional variation in patient risk within England. Bone Joint J 2015;97-B:100-3.
- 18. Pugely AJ, Martin CT, Gao Y, Klocke NF, Callaghan JJ, Marsh JL. A risk calculator for short-term morbidity and mortality after hip fracture surgery. J Orthop Trauma 2014;28:63-9.
- 19. Moppett IK, Parker M, Griffiths R, Bowers T, White SM, Moran CG. Nottingham hip fracture score: Longitudinal and multi-assessment. Br J Anaesth 2012;109:546-50.
- 20. Sökmen F, Ulucaköy C. Can the c-reactive protein to albumin ratio predict mortality due to hemiarthroplasty performed after hip fracture in the elderly population? Türk Geriatri Dergisi 2021;24:79-86.
- 21. Yapar A, Ulucaköy C, Sezgin EA, Atalay İB, Ekşioğlu MF. Diagnostic role of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in patients with enchondroma and low-grade chondrosarcoma. Jt Dis Relat Surg 2020;31:286-90.
- 22. Yapar A, Tokgöz MA, Yapar D, Atalay İB, Ulucaköy C, Güngör BŞ. Diagnostic and prognostic role of neutrophil/ lymphocyte ratio, platelet/lymphocyte ratio, and lymphocyte/monocyte ratio in patients with osteosarcoma. Jt Dis Relat Surg 2021;32:489-96.
- 23. Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth 2011;106:501-4.
- 24. Moppett IK, Wiles MD, Moran CG, Sahota O. The Nottingham Hip Fracture Score as a predictor of early discharge following fractured neck of femur. Age Ageing 2012;41:322-6.
- 25. Atlas A, Duran E, Pehlivan B, Pehlivan VF, Erol MK, Altay N. The effect of increased neutrophil lymphocyte ratio on mortality in patients operated on due to hip fracture. Cureus 2020;12:e6543.
- 26. Yin P, Lv H, Zhang L, Long A, Zhang L, Tang P. Combination of red cell distribution width and American Society of Anesthesiologists score for hip fracture mortality prediction. Osteoporos Int 2016;27:2077-87.
- 27. Forget P, Moreau N, Engel H, Cornu O, Boland B, De Kock M, et al. The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF). Arch Gerontol Geriatr 2015;60:366-71.
- 28. Temiz A, Ersözlü S. Admission neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture. Ulus Travma Acil Cerrahi Derg 2019;25:71-4.
- 29. 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;13:588-602.
- 30. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009;169:588-94.
- 31. Garbharran U, Chinthapalli S, Hopper I, George M, Back DL, Dockery F. Red cell distribution width is an independent predictor of mortality in hip fracture. Age Ageing 2013;42:258-61.
- 32. Lv H, Zhang L, Long A, Mao Z, Shen J, Yin P, et al. Red cell distribution width as an independent predictor of long-term mortality in hip fracture patients: A prospective cohort study. J Bone Miner Res 2016;31:223-33.
- 33. Grewal MUS, Bawale MR, Singh PB, Sandiford MA, Samsani MS. The use of Nottingham Hip Fracture score as a predictor of 1-year mortality risk for periprosthetic hip fractures. Injury 2022;53:610-4.
APA | Karadeniz S, Yurtbay A (2022). Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. , 538 - 546. 10.52312/jdrs.2022.683 |
Chicago | Karadeniz Selami,Yurtbay Alparslan Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. (2022): 538 - 546. 10.52312/jdrs.2022.683 |
MLA | Karadeniz Selami,Yurtbay Alparslan Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. , 2022, ss.538 - 546. 10.52312/jdrs.2022.683 |
AMA | Karadeniz S,Yurtbay A Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. . 2022; 538 - 546. 10.52312/jdrs.2022.683 |
Vancouver | Karadeniz S,Yurtbay A Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. . 2022; 538 - 546. 10.52312/jdrs.2022.683 |
IEEE | Karadeniz S,Yurtbay A "Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score." , ss.538 - 546, 2022. 10.52312/jdrs.2022.683 |
ISNAD | Karadeniz, Selami - Yurtbay, Alparslan. "Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score". (2022), 538-546. https://doi.org/10.52312/jdrs.2022.683 |
APA | Karadeniz S, Yurtbay A (2022). Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Joint diseases and related surgery, 33(3), 538 - 546. 10.52312/jdrs.2022.683 |
Chicago | Karadeniz Selami,Yurtbay Alparslan Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Joint diseases and related surgery 33, no.3 (2022): 538 - 546. 10.52312/jdrs.2022.683 |
MLA | Karadeniz Selami,Yurtbay Alparslan Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Joint diseases and related surgery, vol.33, no.3, 2022, ss.538 - 546. 10.52312/jdrs.2022.683 |
AMA | Karadeniz S,Yurtbay A Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Joint diseases and related surgery. 2022; 33(3): 538 - 546. 10.52312/jdrs.2022.683 |
Vancouver | Karadeniz S,Yurtbay A Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score. Joint diseases and related surgery. 2022; 33(3): 538 - 546. 10.52312/jdrs.2022.683 |
IEEE | Karadeniz S,Yurtbay A "Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score." Joint diseases and related surgery, 33, ss.538 - 546, 2022. 10.52312/jdrs.2022.683 |
ISNAD | Karadeniz, Selami - Yurtbay, Alparslan. "Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score". Joint diseases and related surgery 33/3 (2022), 538-546. https://doi.org/10.52312/jdrs.2022.683 |