Abstract
Background: Inflammation has been reported to play an important role in frailty syndrome. The neutrophil–lymphocyte ratio (NLR) has recently emerged as an informative marker for systematic inflammation. However, few studies have examined the association between NLR and frailty. This study aims to examine the association between NLR and frailty in community-dwelling older adults.Methods: Community-dwelling older adults aged ≥ 65 years in the 2011 (n = 2,354) and 2014 (n = 2,458) waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Frailty status was determined using the 38-item frailty index (FI) and categorized into “robust” (FI ≤ 0.1), “pre-frail” (0.1 < FI ≤ 0.21), or “frail” (FI > 0.21). NLR was calculated using a derived formula: NLR = (white blood cell–lymphocyte)/lymphocyte.Results: A total of 3,267 participants were finally included. In cross-sectional analyses, participants with higher NLR levels had increased likelihood of frailty [the 3rd quartile: adjusted odds ratio (OR) = 1.29; 95% confidence interval (CI): 1.02–1.63; the 4th quartile: OR = 1.59; 95% CI: 1.23–2.02) compared with those in the 1st quartile group. During the 3-year follow-up, 164 of the 1,206 participants, robust or pre-frail at baseline, developed frailty, and 197 of the 562 participants, robust at baseline, developed pre-frailty or frailty. Among the robust and pre-frail participants in 2011, after multivariate adjustment, those in the 4th quartile group had a higher frailty incidence than those in the 1st quartile group (OR = 2.06; 95% CI: 1.18–3.59). Among the robust participants in 2011, those in the 4th quartile group also had a higher pre-frailty or frailty incidence than those in the 1st quartile group (OR = 1.95; 95% CI: 1.07–3.55).Conclusion: Among community-dwelling older adults, higher NLR levels were found to be associated with increased odds of prevalent and incident frailty.
Highlights
Frailty is a common geriatric syndrome characterized by age-associated morphological and physiological changes across multiple systems and organs, resulting in progressive decline of physiological reserve, reduced resilience, and increased vulnerability when exposed to stressors [1]
In cross-sectional analyses, participants with higher neutrophil–lymphocyte ratio (NLR) levels had increased likelihood of frailty [the 3rd quartile: adjusted odds ratio (OR) = 1.29; 95% confidence interval (CI): 1.02–1.63; the 4th quartile: OR = 1.59; 95% CI: 1.23–2.02) compared with those in the 1st quartile group
Hou et al found that a higher NLR level (3rd and 4th quartile of NLR of study sample) is associated with frailty in elderly patients with coronary heart disease (CHD) [19]
Summary
Frailty is a common geriatric syndrome characterized by age-associated morphological and physiological changes across multiple systems and organs, resulting in progressive decline of physiological reserve, reduced resilience, and increased vulnerability when exposed to stressors [1]. The neutrophil–lymphocyte ratio (NLR) has recently emerged as an informative marker for systematic inflammation and has been linked to poor prognosis in several diseases, such as cancers [15], chronic obstructive pulmonary disease (COPD) [16], acute coronary syndrome (ACS) [17], and acute cerebral hemorrhage (ICH) [18]. Few studies have examined NLR as an inflammatory marker of frailty [19, 20]. A study by Nishijima and colleagues showed an association between frailty and NLR in older adults with cancer [20]. All previous studies focused on the association between NLR and frailty were performed in disease-specific (CHD or cancer) study populations and with small sample sizes, so it is unclear whether the association persists in community-dwelling older adults. This study aims to examine the association between NLR and frailty in community-dwelling older adults
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