High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture

Abstract

Purpose The platelet-to-lymphocyte ratio (PLR) has been extensively studied in various diseases. However, the relationship between PLR and hip fracture remains unknown. The aim of this study was to evaluate whether PLR would be an independent prognostic factor in elderly hip fracture patients. Methods Between January 2014 and December 2018, a retrospective cohort study was conducted in a orthopaedic centre, China. A total of 460 hip fracture patients were included. PLR was calculated as the ratio of platelet to lymphocyte counts and divided into high PLR group (≥ 189) and low PLR group (< 189) by using the receiver operating characteristic (ROC) curve. The relationship between PLR and one year all-cause mortality rate was assessed by univariate and multivariate Cox proportional hazard models. Further subgroup analysis stratified by different clinical and biological characteristics was performed to make the results more accurate. Results After a median follow-up of 32.0 months (range, 12.0-75.4), 92 patients (mortality rate: 20.0%) died within one year. PLR was significantly higher in dead patients compared with alive patients (p < 0.05), and high PLR group also had a high mortality rate (32.21% vs. 14.15%, p < 0.001). After multivariate adjustment, high PLR remained an independent predictor for one year all-cause mortality (adjusted hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.02-2.41, p = 0.041). Moreover, advanced age (HR 1.05, 95% CI 1.01-1.08), male (HR 1.62, 95% CI 1.06-2.45), CCI ≥ 2 (HR 2.83, 95% CI 1.64-4.89), conservative treatment (HR 5.94, 95% CI 3.71-9.73), low haemoglobin level (HR 1.02, 95% CI 1.01-1.04), and low albumin level (HR 1.07, 95% CI 1.02-1.13) were independent risk factors for survival. Furthermore, subgroup analysis results were consistent with the main findings in most stratified groups. Conclusion This study highlights that high PLR (≥ 189) is associated with increased one year all-cause mortality in elderly hip fracture patients. As PLR is a simple indicator that can be calculated from the blood routine test, it can be easily performed in usual clinical practice.

The Predictive Role of Platelet-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Young and Middle-Aged Patients with Tibial Plateau Fractures

“…The PLR is an effective predictor of cardiovascular and rheumatic diseases as has been demonstrated in many studies [13,15]. In addition, PLR has been reported to be associated with the prognosis of many severe injuries, dementia, and malignancies in recent years [10,16,26 [27,28].…”

“…The PLR and SII indicators have been widely studied in recent years as immunoin ammatory indicators as they are easy to obtain and cost-effective in clinical application. The PLR has great value in predicting the severity and mortality in many diseases such as hip fracture, in ammatory diseases, malignancy, systemic lupus erythematosus, and cardiovascular disease [10][11][12]15]. Moreover, the SII has been associated with the prognosis of malignancies, post-traumatic thrombosis, and fractures following osteoporosis [16][17][18].…”

“…Recent studies have shown that some blood indicators can serve as potential biomarkers to predict the severity of tissue damage. The platelet-to-lymphocyte ratio, calculated as the absolute platelet count divided by the absolute lymphocyte count, is a predictor of diagnosis and prognosis of a variety of diseases such as hip fracture, in ammatory diseases, cancer, systemic lupus erythematosus, and cardiovascular disease [10][11][12][13]. Moreover, there is a critical balance between the pro-in ammatory and anti-in ammatory systems in a traumatic immune response [14].…”

“…]. For example,Wang et al found that patients with a high PLR (≥ 189) had a higher one-year mortality rate than patients with low PLR (< 189)[10]. Mao et al found that PLR > 193.55 in patients indicates malnutrition and more advanced cancer stage[12].…”

Platelet-Lymphocyte and Neutrophil-Lymphocyte Ratio for Prediction of Hospital Outcomes in Patients with Abdominal Trauma

“…Moreover, a recent data showed that both NLR and PLR are reliable preoperative predictive markers of the postoperative overall survival and recurrence-free survival in patients with hepatocellular carcinoma [26]. Previously, few studies have tested the usefulness of PLR and NLR for predicting the outcomes in trauma patients [27][28][29][30][31][32]. However, the use of these ratios has not yet been evaluated in patients with abdominal trauma.…”