Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture

Baosheng Jing; Dangui Chen; Huming Dai; Jingrui Liu; Cheng Chen; Mingjun Dai; Jing Hu; Zhengfeng Lu; Jianjun Wang

doi:10.1016/j.heliyon.2023.e22314

Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture

Heliyon. 2023 Dec 1;9(12):e22314. doi: 10.1016/j.heliyon.2023.e22314. eCollection 2023 Dec.

Authors

Baosheng Jing¹, Dangui Chen², Huming Dai¹, Jingrui Liu¹, Cheng Chen¹, Mingjun Dai¹, Jing Hu¹, Zhengfeng Lu³, Jianjun Wang¹

Affiliations

¹ Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China.
² Department of Hematology, AnQing Municipal Hospitals, Anqing, China.
³ Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.

Abstract

Background: and purpose: Postoperative fatigue (POF) is a common and distressing post-operative symptom. This study aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) and POF in elderly patients with hip fracture.

Method: Elderly patients (age ≥65 years) with acute hip fracture admitted to the Department of Orthopedics of Anqing Municipal Hospital from June 2018 to June 2020 were included. Fatigue was assessed using the Fatigue Severity Scale at the 3-month follow-up postoperatively. Univariate and multivariate analyses were performed to explore the associations between NLR and POF. The diagnostic performance of NLR was analysed using Receiver Operating Characteristic (ROC) curve analysis and the Delong test.

Result: A total of 321 elderly patients with hip fractures were included; 120 (37.4 %) of them were diagnosed with POF. Univariate analysis indicated significant differences in NLR, platelet-to-lymphocyte ratio (PLR), education, neutrophil count, lymphocyte count, Hamilton Depression Scale (HAMD) and Insomnia Severity Index (ISI) scores (P < 0.05). Multivariate analysis indicated neutrophil count (odds ratio [OR], 1.46; 95 % confidence interval [CI] 1.27-1.67), lymphocyte count (OR 0.32, 95 % CI 0.19-0.53), NLR (OR1.81, 95 % CI 1.50-2.17) and PLR (OR 1.005, 95 % CI 1.001-1.009) were significantly associated with POF. The areas under the ROC curves (AUCs) of neutrophil count, lymphocyte count, NLR and PLR were 0.712, 0.667, 0.775 and 0.605, respectively. The Delong test indicated that NLR had the best diagnostic performance (p < 0.05).

Conclusion: NLR independently predicts POF in elderly patients with acute hip fracture.

Keywords: Hip fracture; Neutrophil-to-lymphocyte ratio; Postoperative fatigue.