入院中性粒细胞与淋巴细胞比值对老年髋部骨折患者预后的预测价值

目的 探讨入院中性粒细胞与淋巴细胞比值（NLR）对老年髋部骨折患者预后的预测价值。方法 连续纳 入2014年1月—2019年12月收治的老年髋部骨折患者725例，收集患者的年龄、性别、骨折情况、治疗方式和实验室 检查等临床资料。根据入院血常规结果计算NLR值，利用受试者工作特征（ROC）曲线确定NLR值的最佳截断值，将 患者分为低NLR组和高NLR组。电话随访患者生存情况，Kaplan-Meier法绘制2组患者的生存曲线，Cox比例风险模 型分析影响预后的危险因素。结果 NLR值的最佳截断值为10.08，以此将患者分为低NLR组（NLR≤10.08，520例） 和高NLR组（NLR＞10.08，205例）。中位随访34.64个月（12~89个月），其中30 d内死亡45例（6.21%）；6个月内死亡 105 例（14.48%）；1 年内死亡 149 例（20.55%）。与低 NLR 组相比，高 NLR 组 30 d、6 个月和 1 年病死率更高（均 P＜ 0.05）。多因素Cox回归分析显示，高NLR值、男性、Charlson合并症指数（CCI）≥1、保守治疗、白蛋白水平降低及血肌 酐升高是影响老年髋部骨折患者1年内死亡的独立危险因素（均P＜0.05）。结论 入院NLR值可作为临床预测老年 髋部骨折患者预后的指标。

The predictive value of neutrophil to lymphocyte ratio in elderly patients with hip fracture

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) on admission for prognosis in elderly patients with hip fracture. Methods A total of 725 consecutive patients were retrospectively enrolled in this study from January 2014 to December 2019. Clinical data such as age, gender, fracture information, treatment and laboratory tests were collected. NLR was calculated based on the blood routine result on admission, and the receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of NLR. Patients were divided into low NLR group and high NLR group. Survival situation was obtained from telephone follow-up, and the survival curves of patients were plotted using the Kaplan-Meier method in high NLR and low NLR groups. Cox proportional hazard model was used to analyze the risk factors affecting the prognosis. Results The optimal cut-off value of NLR was 10.08. Patients were divided into low NLR group (NLR≤10.08, n=520) and high NLR group (NLR＞10.08，n=205). The median follow-up time was 34.64 months (12~89 months), of which 45 (6.21%) died within 30-day, 105 (14.48%) in 6-month and 149 (20.55%) in 1-year. Compared with low NLR group, high NLR group showed higher fatality rates at 30-day, 6-month and 1-year (all P< 0.05). Multi-factor Cox regression analysis showed that high NLR value, male, Charlson comorbidity index (CCI) ≥1, conservative treatment, reduced albumin and elevated serum creatinine were independent risk factors for the 1-year mortality in elderly hip fracture patients (all P<0.05). Conclusion The NLR value of admission can be used as a clinical indicator to predict the prognosis in elderly patients with hip fracture.