Comparing the Prognostic Roles of Red Blood Cell Volume Distribution Width, Neutrophil–Lymphocyte Ratio, and Platelet–Lymphocyte Ratio for Predicting Mortality after Hip Fracture in the Geriatric Population (Preprint)

Abstract

BACKGROUND Hip fractures have adverse effects on older adults, often resulting in reduced functional independence, increased social costs, morbidity, and an elevated risk of mortality within 1 year after surgery. Prognostic markers such as red blood cell volume distribution width (RDW), the neutrophil–lymphocyte ratio (NLR), and the platelet–lymphocyte ratio (PLR) have been used to predict outcomes following hip fracture surgery; however, their prediction accuracy has varied across studies. OBJECTIVE This study aims to compare the prognostic accuracy of RDW, NLR, and PLR in predicting the mortality of older adults after hip fracture surgery. METHODS This study enrolled 469 patients who underwent hip fracture surgery and were followed up for 1 year at a single tertiary medical center from December 2018 to May 2022. The patients’ preoperative RDW, NLR, and PLR levels were measured, and data on their clinical characteristics were collected. Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) were used to assess the predictive accuracy of these markers for 1-month, 3-month, and 1-year mortality. RESULTS Among the patients, the mean age was 81.2 years, and 2.6%, 4.1%, and 13.9% died within 1 month, 3 months, and 1 year after surgery, respectively. RDW, NLR, and PLR were nonsignificant predictors of 1-month mortality, but RDW was the sole significant predictor of 3-month and 1-year mortality. The cutoff values for RDW were 15.05% and 13.65% for 3-month and 1-year mortality, respectively. Among the patients aged 60–80 years, RDW was a significant predictor of mortality following hip fracture surgery (AUC: 1 month, 0.83; 3 month, 0.86). However, for the patients aged >80 years, all three markers were nonsignificant predictors. CONCLUSIONS RDW was a robust prognostic factor that outperformed NLR and PLR in predicting the mortality of patients aged >60 years who underwent hip fracture surgery. Furthermore, the predictive accuracy of RDW was even higher for 1-month and 3-month mortality of patients aged 60–80 years who underwent hip fracture surgery.