The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF)

Abstract

BackgroundThe NLR is a prognostic factor for outcome and survival in cardiology, oncology and digestive surgery. NLR has not yet been studied in HF. MethodsRetrospective analysis of a prospective cohort of 247 consecutive patients, older than 65years, operated for HF. Mortality at 12months was registered, as the perioperative NLR values. ResultsAfter hip surgery in the 247 patients (women 71%, median age 85 years, range: 66–102), the mortality was 27.2% [95%confidence interval (CI): 21.4–33.0] at 12months. Univariate analysis detected four risk factors for mortality: age (Hazard Ratio (HR) – by 10year-increments: 2.08 [95%CI: 1.37–3.17], P<0.001), male gender (HR: 1.92 [95%CI: 1.17–3.14], P=0.009, MCM (≥3) (HR: 1.71 [95%CI: 1.006–2.92], P=0.047 and NLR > 5 at day 5 (HR: 1.8 [95%CI: 1.11–2.94], P=0.002). In multivariate analysis, two factors remained significantly associated with mortality: age (HR: 2.28 [95%CI: 1.49–3.47], P<0.001) and male gender (HR: 2.26 [95%CI: 1.38–3.72], P=0.001). Two independent risk factors of postoperative cardiovascular complications were identified: NLR > 5 at day 5 (Odds Ratio (OR): 3.34 [95%CI: 2.33–4.80], P=0.001) and MCM (OR: 3.04 [95%CI: 2.16–4.29], P=0.006). A higher risk of infection was independently associated with a NLR > 5 at day 5 (OR: 2.12 [95%CI: 1.44–3.11], P=0.02). ConclusionsThe NLR at fifth postoperative day is a risk factor of postoperative mortality and cardiovascular complications.