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Abstract：
Objectives: This study, based on the concept of immuno-inflammatory-metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF patient (n = 1273, mean age 82.9 ± 8.7 years, 73.5% females) demographics, medical history, laboratory parameters, and outcomes were recorded prospectively. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were used to establish the predictive role for each biomarker. Results: Among 27 IIM biomarkers, 10 indices were significantly associated with development of PMI and 16 were indicative of a fatal outcome; in the subset of patients aged >80 years with ischaemic heart disease (IHD, the highest risk group: 90.2% of all deaths), the corresponding figures were 26 and 20. In the latter group, the five strongest preoperative predictors for PMI were anaemia (AUC 0.7879), monocyte/eosinophil ratio > 13.0 (AUC 0.7814), neutrophil/lymphocyte ratio > 7.5 (AUC 0.7784), eosinophil count < 1.1 × 109/L (AUC 0.7780), and neutrophil/albumin × 10 > 2.4 (AUC 0.7732); additionally, sensitivity was 83.1-75.4% and specificity was 82.1-75.0%. The highest predictors of in-hospital death were platelet/lymphocyte ratio > 280.0 (AUC 0.8390), lymphocyte/monocyte ratio < 1.1 (AUC 0.8375), albumin < 33 g/L (AUC 0.7889), red cell distribution width > 14.5% (AUC 0.7739), and anaemia (AUC 0.7604), sensitivity 88.2% and above, and specificity 85.1-79.3%. Internal validation confirmed the predictive value of the models. Conclusions: Comparison of 27 IIM indices in HF patients identified several simple, widely available, and inexpensive parameters highly predictive for PMI and/or in-hospital death. The applicability of IIM biomarkers to diagnose and predict risks for chronic diseases, including OP/OF, in the preclinical stages is discussed.
摘要：
目的:本研究,基于免疫炎症代谢（IIM）失调的概念，调查并比较了入院时27项指标对预测髋部骨折(HF)患者术后心肌损伤(PMI)和/或住院死亡的预后影响.方法：在连续HF患者中（n=1273，平均年龄82.9±8.7岁，73.5%女性）人口统计学，病史,实验室参数,并前瞻性记录结局.多元逻辑回归和接受者操作特征分析(曲线下面积，AUC)用于建立每个生物标志物的预测作用。结果：在27个IIM生物标志物中，10个指标与PMI的发展显着相关，16个指标指示致命的结果；在年龄>80岁的缺血性心脏病患者中（IHD，最高风险组：所有死亡的90.2%），相应的数字是26和20。在后一组中，PMI的五个最强的术前预测因子是贫血（AUC0.7879），单核细胞/嗜酸性粒细胞比值>13.0（AUC0.7814），中性粒细胞/淋巴细胞比值>7.5（AUC0.7784），嗜酸性粒细胞计数<1.1×109/L（AUC0.7780），中性粒细胞/白蛋白×10>2.4(AUC0.7732)；此外，敏感性为83.1-75.4%,特异性为82.1-75.0%.住院死亡的最高预测因素是血小板/淋巴细胞比值>280.0（AUC0.8390），淋巴细胞/单核细胞比率<1.1（AUC0.8375），白蛋白<33g/L（AUC0.7889），红细胞分布宽度>14.5%（AUC0.7739），和贫血（AUC0.7604），灵敏度88.2%及以上，特异性85.1-79.3%。内部验证证实了模型的预测价值。结论：对HF患者的27项IIM指标进行比较，确定了几种简单的，广泛可用，和廉价的参数对PMI和/或院内死亡具有很高的预测性。IIM生物标志物诊断和预测慢性病风险的适用性，包括OP/OF，在临床前阶段进行了讨论。
