Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up

Yin, Pengbin; Lv, Houchen; Li, Y; Meng, Yutong; Zhang, L; Tang, Peifu

doi:10.1007/s00198-018-4516-7

Cited by 16 publications

(14 citation statements)

References 40 publications

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“…[15] There are also studies in which NLR, RDW, or NHFS are emphasized for their prognostic value in predicting mortality. [5,6,13,14,24] In previous studies, NLR was significantly correlated with the one-year mortality rate following hip fractures. [27,28] In one of these studies, Forget et al [27] reported that NLR-D5 >5 was a risk factor for postoperative mortality in patients with hip fractures.…”

Section: Discussionmentioning

confidence: 83%

“…[11,12] In a study, a correlation was reported between the increased RDW values and poor surgical outcomes or higher mortality in patients with osteoporotic fractures. [13] Thus, preoperative RDW levels may be used combined with clinical and laboratory findings to improve the risk stratification of elderly patients who are at risk for proximal femoral fractures. [14] Various risk parameters have been used to classify high-risk hip fractures in elderly patients.…”

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confidence: 99%

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Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Karadeniz

Yurtbay

2022

Jt Dis Relat Surg

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The ability to identify patients at high risk for poor outcomes before hip fracture operations is clinically important, as hip fractures may result in mortality or insufficiency in daily living activities in the elderly population. [1] Due to the high mortality rates associated with hip fractures, identifying high-risk patients is critical in terms of treatment management and prevention of a substantial economic burden on healthcare services. [2] In addition, preoperative identification of high-risk patients may be helpful for optimal timing of the operation, administration of critical care during the treatment, preparation of patient-specific informed consent, and developing a better understanding of the prognosis.Objectives: In this study, we aimed to compare the neutrophil-tolymphocyte ratio (NLR), red blood cell distribution width (RDW), and Nottingham Hip Fracture Score (NHFS) according to one-year mortality estimation after hip fracture surgery in elderly.Patients and methods: Between January 2015 and December 2019, a total of 190 elderly patients (63 males, 127 females; mean age: 82.8±6.1 years; range, 70 to 98 years) who were diagnosed with collum femoris fractures treated with hemiarthroplasty were included. The cohort was divided into two groups with NHFS ≤4 and >4 as the low-and high-risk patients, respectively and one-year mortality was assessed for both groups. The RDW was evaluated with blood values sampled on the day of admission. A cut-off of 14.5% was considered for the RDW values. The NLR values calculated on admission (NLR-D0) and postoperative Day 5 (NLR-D5) were considered the primary outcome measures.Results: A total of 46 patients (24.2%) developed any type of complication. The NLR values higher than 5 on Days 0 and 5 were more frequently seen in the complicated patients (p=0.0016 and p<0.001). There were significantly more patients with higher RDW values (>14.5%) in the complicated group (p<0.001). The median NHFS and the rate of patients with NHFS >4 were significantly higher in the complicated patients (p<0.001 for both). The NHFS value higher than 4 had a sensitivity of 87.7% and specificity of 84.0% in predicting mortality (area under the curve [AUC]= 0.910, 95% confidence interval [CI]: 0.860-0.947, p<0.001). Estimation of mortality using an RDW cut-off value of >14.5 showed 87.7% and 80.0% sensitivity and specificity, respectively (95% CI: 0.789-0.904, p<0.001). The AUC of the NLR Day 5 using a cut-off value of >6.8 was 0.953 for the prediction of mortality (95% CI: 0.912-0.978, p<0.001). Conclusion:Age, NLR Day 5 (>5), RDW (>14.5%) and NHFS (>4) were strongly associated with mortality prediction. The NHSF and RDW values had the highest and similar sensitivity merit, while the highest specificity was in NLR-D5. Therefore, NLR, RDW and NHFS values can be used to classify risk factors in estimating one-year mortality rates in elderly patients operated for hip fractures. A multidisciplinary approach should be standardized in determining the risk factors before treatment in patients with...

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Section: Discussionmentioning

confidence: 83%

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confidence: 99%

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Karadeniz

Yurtbay

2022

Jt Dis Relat Surg

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“…Loss of appetite in elderly patients decreases the intake of iron, folic acid, and vitamin B, which are vital to erythrocyte maturation. RDW is a prognostic factor for many diseases and can predict all causes of death [ 37 , 38 ]; however, the underlying mechanism and function in frailty warrant further research.…”

Section: Discussionmentioning

confidence: 99%

Inflammation markers are associated with frailty in elderly patients with coronary heart disease

Hou

Xue

Mao

et al. 2018

Aging

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The neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are important indicators of adverse outcomes and have predictive value for many diseases; however, the relationships between frailty, and the NLR and RDW in patients with coronary heart disease (CHD) have not been determined. In this cross-sectional study, we investigated the association between frailty, and the NLR and RDW in elderly CHD patients ≥ 60 years of age. Frailty was defined according to frailty phenotype. Of 345 patients enrolled in the study, 22.6%, 58.3%, and 19.1% were characterized as robust, pre-frail, and frail, respectively. A significant positive correlation was observed between frailty and the NLR (r = 0.169) and RDW (r = 0.196). After adjusting for confounders, linear regression analyses showed that participants in the 4th quartile of the NLR or RDW were more likely to have a higher frailty phenotype score. Based on multivariable logistic regression, patients in the 4th quartile of the NLR and RDW, the fully-adjusted odds ratios for incident frailty were 2.894 (p = 0.011) and 2.494 (p = 0.040), respectively. Our findings indicate that frailty is associated with the NLR and RDW in elderly patients with CHD.

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“…Interestingly, several studies have recently reported that RDW value is associated with adverse aging‐related nonhematologic health outcomes, especially cardiovascular diseases, mortality, and poorer outcomes in critically ill patients . It has been also reported that increased RDW value is associated with poor surgical outcomes or higher mortality rate in patients with osteoporotic fractures . However, no studies have addressed whether RDW index is associated with the future risk of hip fractures or other clinical fractures.…”

Section: Introductionmentioning

confidence: 99%

Red Cell Distribution Width Is a Risk Factor for Hip Fracture in Elderly Men Without Anemia

Kim

Lui

Cauley

et al. 2020

Journal of Bone and Mineral Research

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Red cell distribution width (RDW), routinely assessed as a component of a complete blood count (CBC), quantifies the variation in the size of red blood cells. It increases with age, and increased RDW predicts many aging-related diseases and mortality. However, whether it also predicts hip fracture is unknown. We prospectively evaluated the association between RDW and hip fracture using data from the Osteoporotic Fracture in Men (MrOS) study. RDW was measured in 3635 men (aged 71 to 99 years) along with bone mineral density (BMD) in MrOS. RDW ranged from 11.3% to 32.9% (median 14.0%; interquartile range 13.5% to 14.8%) and was categorized into four groups (≤13.0%, 13.1% to 14.0%, 14.1% to 15.0%, ≥15.1%). Study participants with a hemoglobin level <13.0 g/dL were classified as having anemia. During an average 8.1 years, 164 men suffered hip fractures. The risks of hip fractures increased with increase of RDW category. Furthermore, there was a significant interaction between anemia and RDW: An association between RDW and hip fractures was only observed in participants without anemia. In those without anemia, the relative hazard of hip fractures increased with increases in RDW category: Men in the highest RDW category had a 2.8 times higher risk of hip fractures than men in the lowest group (95% confidence interval 1.1 to 7.1). The risks of all-clinical fractures were also increased along with higher RDW values. Additionally, RDW was significantly associated with the risk of having a fall but not with femoral neck or total hip BMD. In conclusion, RDW and anemia defined by hemoglobin are widely available routine laboratory measurements that together could indicate increased risk of hip fracture, reflecting the neuromuscular effects of aging rather than lower hip BMD.

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Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up

Abstract: Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.

Cited by 16 publications

References 40 publications

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Predicting mortality rate in elderly patients operated for hip fracture using red blood cell distribution width, neutrophil-to-lymphocyte ratio, and Nottingham Hip Fracture Score

Inflammation markers are associated with frailty in elderly patients with coronary heart disease

Red Cell Distribution Width Is a Risk Factor for Hip Fracture in Elderly Men Without Anemia

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