Impact of hematologic inflammatory markers on the prognosis of geriatric hip fracture: a systematic review and meta-analysis

BACKGROUND: Geriatric hip fractures pose a significant health burden, and inflammation may play a role in the short- and long-term prognosis. However, the prognostic significance of hematologic inflammatory markers in geriatric patients with fractures is not understood. The aim of this systematic review and meta-analysis was to assess the prognostic implications of systemic inflammatory markers on the long-term mortality of older patients with hip fractures.

METHODS: PubMed, EMBASE, and Cochrane CENTRAL were searched from inception to December 19, 2023. Prospective, retrospective cohort, and case-control studies investigating the prognostic impact of hematologic inflammatory markers on mortality after hip fracture were eligible. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated to determine the associations between the markers and mortality risk, with heterogeneity assessed by I2 statistic. The quality of the studies was appraised using the Newcastle-Ottawa Scale.

RESULTS: Ultimately, 7 retrospective studies involving a total of 7212 patients were included. The meta-analysis revealed that the neutrophil-to-lymphocyte ratio (NLR) (HR = 1.04, 95% CI 1.02-1.08), systemic immune-inflammatory index (SII) (HR = 1.03, 95% CI 1.01-1.05), and red cell distribution width (RDW) (HR = 1.07, 95% CI 1.01-1.14) independently correlated with increased long-term mortality.

CONCLUSIONS: Elevated NLR, SII, and RDW are independently associated with increased long-term mortality in older patients with hip fractures. These findings imply the potential value of incorporating these inflammatory indicators to aid in prognostic stratification of geriatric patients with hip fractures.