JOA - 2026-06-19 - Journal Article
Neutrophil-Lymphocyte Ratio Trajectories Predict Mortality and Medical Complications in Hip Fracture Patients Undergoing Hemiarthroplasty.
Wier J, Jones IA, Kumaran P, Telang SS, Lieberman JR, Patterson JT, Heckmann ND
Topics
Key Takeaway
Non-resolving NLR trajectory after hemiarthroplasty carries a 5.4-fold increased odds of mortality (15.3% vs. 1.8%) compared to a blunted inflammatory phenotype.
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Summary
This study used latent profile analysis on a large national database (2016–2023) to classify hemiarthroplasty patients into four postoperative NLR trajectory phenotypes and assessed their association with in-hospital mortality and medical complications. Non-resolving phenotypes (1.8% of cohort) had 15.3% mortality vs. 1.8% in blunted phenotypes (aOR 5.4, 95% CI 2.2–8.9), and delayed phenotypes had 6.0% mortality (aOR 2.3, 95% CI 1.5–3.6). Medical complication rates followed the same gradient: 67.1% in non-resolving vs. 36.1% in blunted phenotypes (aOR 2.2, 95% CI 1.5–3.1).
Key Limitation
The observation window ends at postoperative day 2, so trajectory classification is based on an extremely narrow perioperative interval that may not capture clinically meaningful inflammatory evolution beyond the acute phase.
Original Abstract
BACKGROUND
Hip fractures are associated with high rates of mortality and medical complications. The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker gaining recognition as a prognostic indicator. Here we sought to identify a high-risk patient population with a pathologic postoperative inflammatory response using NLR trajectories.
METHODS
Patients ≥ 55 years old who underwent hemiarthroplasty for intracapsular proximal femur fracture were identified using a large national database from 2016 to 2023. Latent profile analysis was conducted to classify four distinct NLR trajectories from preoperative day one to postoperative day two. Mixed effect multivariable models were conducted to evaluate the adjusted odds ratio (aOR) of the NLR class on mortality and medical complications.
RESULTS
There were 9,282 patients designated "Blunted Phenotype," "Resolving Phenotype," "Delayed Phenotype," and "Non-resolving Phenotype," representing 73.6, 19.2, 5.4, and 1.8% of the cohort, respectively. In the adjusted analyses, each class carried higher rates and odds of mortality compared with blunted phenotypes (1.8%): resolving phenotypes (3.4%) (aOR = 1.5, 95% confidence interval (CI) = 1.1 to 2.0), delayed phenotypes (6.0%) (aOR = 2.3, 95% CI = 1.5 to 3.6), and non-resolving phenotypes (15.3%) (aOR = 5.4, 95% CI = 2.2 to 8.9). Similarly, unique NLR trajectories were associated with medical complications when compared to blunted phenotypes (36.1%): resolving phenotypes (45.7%) (aOR = 1.2, 95% CI = 1.1 to 1.4), delayed phenotypes (56.4%) (aOR = 1.7, 95% CI = 1.4 to 2.0), and non-resolving phenotypes (67.1%) (aOR = 2.2, 95% CI = 1.5 to 3.1).
CONCLUSION
The NLR trajectories following hip fracture surgery are predictive of mortality. Patients who have incomplete or failed resolution of early inflammation experience significantly higher rates of mortality and medical complications.