术前淋巴细胞/C反应蛋白比值与老年髋部骨折患者1年死亡率的关系

Relationship between preoperative lymphocyte/C-reactive protein ratio and 1-year mortality in elderly patients with hip fracture

目的探讨老年髋部骨折患者术后1年内死亡风险因素及术前淋巴细胞/C反应蛋白比值(LCR)和术后1年死亡率的关系。方法分析2019年1月至2021年11月在郑州大学第一附属医院因髋部骨折接受手术治疗的465例老年患者临床资料。根据患者术后1年生存情况分为存活组与死亡组,单因素分析各组在性别、年龄、体重指数(BMI)、查尔森合并症指数(CCI)、骨折类型、美国麻醉医师协会(ASA)分级、手术方式、麻醉方法、术中出血量、术中输血、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)及LCR统计学差异,绘制NLR、PLR、LCR预测老年髋部骨折术后1年死亡的受试者工作特征(ROC)曲线,并获得曲线下面积(AUC)和最佳截断值。采用多因素Logistic回归分析得到老年髋部骨折术后1年死亡的独立危险因素。结果65例患者术后1年内死亡,死亡率为13.98%。单因素分析结果显示,存活组与死亡组在性别(χ^(2)=9.677,P<0.05)、年龄(Z=-3.184,P<0.05)、CCI(Z=-2.109,P<0.05)、ASA分级Ⅲ或Ⅳ级(χ^(2)=14.213,P<0.001)、NLR(Z=-2.713,P<0.05)和LCR(Z=-3.846,P<0.001)差异均有统计学意义。ROC曲线确定NLR、PLR、LCR最佳截断值(AUC,P值)分别为5.06(0.605,P<0.05)、0.563(416.94,P>0.05)和0.05(0.649,P<0.05)。Logistic多因素分析结果显示,性别[比值比(OR)=2.335,P<0.05]、年龄(OR=1.044,P<0.05)、ASAⅢ或Ⅳ级(OR=2.236,P<0.05)和LCR≤0.05(OR=2.591,P<0.05)是老年髋部骨折术后1年死亡的独立危险因素。结论年龄、性别、ASA分级、LCR≤0.05是老年髋部骨折术后1年死亡的独立危险因素,LCR能有效预测老年髋部骨折术后1年死亡率。

Objective To analyze the risk factors related to the death risk of hip fracture in the elderly and the relationship between lymphocyte/C-reactive protein ratio(LCR)and postoperative 1-year mortality.Methods From January 2019 to November 2021,the clinical data of 465 elderly patients with hip fractures treated in the First Affiliated Hospital of Zhengzhou University were analyzed.Patients were divided into survival group and death group according to their 1-year survival status.Univariate analysis of statistical differences was carried out in gender,age,body mass index(BMI),Charlson complication index(CCI),fracture type,American Society of Anesthesiologists(ASA)grade,operation method,anesthesia method,blood loss,blood transfusion,neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)and LCR between the two groups.The receiver operativng characteristic(ROC)curves of NLR,PLR and LCR used to predict 1-year mortality in the elderly patients with hip fracture were worked out to the optimal cutoff points[area under the curve(AUC),P value].Multivariate Logistic regression analysis was used to obtain the risk factors for 1-year death after hip fracture surgery in the elderly.Results A total 65 patients died within 1 year after operation,and the mortality rate was 13.98%.Univariate analysis showed that there were significant differences in gender(χ^(2)=9.677,P<0.05),age(Z=-3.184,P<0.05),CCI(Z=-2.109,P<0.05),ASA grade Ⅲ and Ⅳ(χ^(2)=14.213,P<0.001),NLR(Z=-2.713,P<0.05)and LCR(Z=-3.846,P<0.001)between the survival group and the death group.The optimal cutoff values of NLR,PLR and LCR determined by the ROC curve were 5.06(0.605,P<0.05),0.563(416.94,P>0.05)and 0.05(0.649,P<0.05).Logistic multivariate analysis showed that gender[odds ratio(OR)=2.335,P<0.05],age(OR=1.004,P<0.05),ASA gradeⅢandⅣ(OR=2.236,P<0.05),LCR≤0.05(OR=2.591,P<0.05)were independent risk factors for 1-year mortality.Conclusion Gender,age,ASA gradeⅢandⅣand LCR≤0.05 were independent risk factors for 1-year death after surgery in elderly patients with hip fracture.The preoperative LCR can predict 1-year mortality after surgery.