目的:老年患者髋部骨折与高死亡率相关。与髋部骨折相关的大多数死亡是由手术后的并发症引起的。最近的研究表明,一些炎症生物标志物可能有助于估计超额死亡率。本研究旨在探讨老年髋部骨折患者入院时炎症标志物的预测价值。
方法:我们报告了2015年1月至2019年12月中国某医院收治的老年髋部骨折患者的回顾性研究。共有1085名患者被纳入研究,并对其人口统计及术前特征进行分析。炎症生物标志物包括单核细胞与淋巴细胞比率(MLR),中性粒细胞与淋巴细胞比率(NLR),C反应蛋白(CRP)与白蛋白比值(CAR)。NLR的预测性能,通过受试者工作特征(ROC)曲线分析评估MLR和CAR,并通过Cox比例回归评估入院炎症标志物与死亡率之间的相关性。
结果:30天,1年,2年,4年死亡率为1.6%,11.5%,21.4%和48.9%,分别。准入NLR的最佳截止值,1年死亡率的MLR和CAR分别为7.28、0.76和1.36。调整协变量后,术前NLR≥7.28(HR=1.419,95%CI:1.080-1.864,p=0.012)是4年全因死亡率的独立危险因素,术前CAR≥1.36与1年独立相关(HR=1.700,95%CI:1.173-2.465,p=0.005),2年(HR=1.464,95%CI:1.107-1.936,p=0.008),和4年(HR=1.341,95%CI:1.057-1.700,p=0.016)全因死亡率,虽然年龄,CCI得分,入院时低血红蛋白也是术后全因死亡的危险因素.
结论:入院CAR和NLR可能是预测老年髋部骨折手术患者长期死亡率的有用指标。需要更多的研究来验证这些发现。
OBJECTIVE: Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This
study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture.
METHODS: We reports on a retrospective
study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the
study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression.
RESULTS: The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality.
CONCLUSIONS: Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.