Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2024 | Research article

Combined Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) predict survival in elderly patients with hip fractures: a retrospective study

Authors: Ling Zhou, Chao Huang, Xianjie Zhu, Zhenhua Ma

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Purpose

The Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) have undergone comprehensive examination and validation in forecasting the outcomes of diverse medical conditions. Nevertheless, the correlation between the combined use of GNRI and SII metrics and hip fractures has yet to be elucidated. This study aimed to determine whether the amalgamation of SII and GNRI scores constitutes an independent prognostic factor for elderly patients with hip fractures.

Methods

We conducted a retrospective analysis of elderly patients admitted to our facility with hip fractures, encompassing both femoral neck and intertrochanteric fractures. Demographic information, experimental parameters, and postoperative complications were systematically recorded. The Geriatric Nutritional Risk Index (GNRI) and Systemic Immunoinflammatory Index (SII) were meticulously computed. Receiver operating characteristic (ROC) curves were generated, and optimal cutoff values for each parameter were determined. Subsequently, a multivariate Cox regression analysis was employed to assess the predictive utility of the SII–GNRI score in relation to 1-year postoperative mortality among elderly patients with hip fractures.

Results

In a study involving 597 patients, 90 of whom experienced mortality within 1 year, it was observed that the SII-GNRI score in the group of patients who passed away was significantly higher compared to the group that survived. Following a multifactorial adjustment, it was established that a high SII–GNRI score served as an independent predictor of 1-year all-cause mortality in older patients with hip fractures. In addition to the SII–GNRI score, factors such as length of hospital stay, CCI > 2, and blood transfusion were also identified as independent risk factors for survival. Notably, the incidence of postoperative complications in patients with high SII–GNRI scores was significantly greater than in patients with low scores.

Conclusion

The SII–GNRI score proves valuable in predicting the 1-year survival rate for elderly patients with hip fractures who have undergone surgery.

Kim CS, Han KD, Jung JH, Choi HS, Bae EH, Ma SK, et al. Incidence and risk factors for osteoporotic fractures in patients with systemic lupus erythematosus versus matched controls. Korean J Intern Med. 2021. https://doi.org/10.3904/kjim.2018.378.CrossRefPubMedPubMedCentral

Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteop Int J Estab Result Cooper Eur Found Osteop Natl Osteop Found USA. 2009. https://doi.org/10.1007/s00198-009-0920-3.CrossRef

Gargano G, Poeta N, Oliva F, Migliorini F, Maffulli N. Zimmer Natural Nail and ELOS nails in pertrochanteric fractures. J Orthop Surg Res. 2021. https://doi.org/10.1186/s13018-021-02634-9.CrossRefPubMedPubMedCentral

Marsillo E, Pintore A, Asparago G, Oliva F, Maffulli N. Cephalomedullary nailing for reverse oblique intertrochanteric fractures 31A3 (AO/OTA). Orthop Rev. 2022. https://doi.org/10.52965/001c.38560.CrossRef

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteop Int J Estab Result Cooper Eur Found Osteop Natl Osteop Found USA. 1997. https://doi.org/10.1007/pl00004148.CrossRef

Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 2018. https://doi.org/10.2147/cia.S150067.CrossRefPubMedPubMedCentral

Liu Y, Wang Z, Xiao W. Risk factors for mortality in elderly patients with hip fractures: a meta-analysis of 18 studies. Aging Clin Exp Res. 2018. https://doi.org/10.1007/s40520-017-0789-5.CrossRefPubMedPubMedCentral

Arshi A, Lai WC, Iglesias BC, McPherson EJ, Zeegen EN, Stavrakis AI, et al. Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int J Clin Exp Res Hip Pathol Therapy. 2021. https://doi.org/10.1177/1120700019897878.CrossRef

Maffulli N, Aicale R. Proximal femoral fractures in the elderly: a few things to know, and some to forget. Medicina. 2022. https://doi.org/10.3390/medicina58101314.CrossRefPubMedPubMedCentral

10.

Yin M, Yan Y, Fan Z, Fang N, Wan H, Mo W, et al. The efficacy of enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures who received surgery: study protocol for a randomized, blinded, controlled trial. J Orthop Surg Res. 2020. https://doi.org/10.1186/s13018-020-01586-w.CrossRefPubMedPubMedCentral

11.

Tian Y, Zhu Y, Zhang K, Tian M, Qin S, Li X, et al. Incidence and risk factors for postoperative pneumonia following surgically treated hip fracture in geriatric patients: a retrospective cohort study. J Orthop Surg Res. 2022. https://doi.org/10.1186/s13018-022-03071-y.CrossRefPubMedPubMedCentral

12.

Chen YP, Kuo YJ, Hung SW, Wen TW, Chien PC, Chiang MH, et al. Loss of skeletal muscle mass can be predicted by sarcopenia and reflects poor functional recovery at one year after surgery for geriatric hip fractures. Injury. 2021. https://doi.org/10.1016/j.injury.2021.08.007.CrossRefPubMed

13.

Quaranta M, Miranda L, Oliva F, Migliorini F, Pezzuti G, Maffulli N. Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician. J Orthop Surg Res. 2021. https://doi.org/10.1186/s13018-021-02524-0.CrossRefPubMedPubMedCentral

14.

Harris AHS, Trickey AW, Eddington HS, Seib CD, Kamal RN, Kuo AC, et al. A tool to estimate risk of 30-day mortality and complications after hip fracture surgery: accurate enough for some but not all purposes? A study from the ACS-NSQIP database. Clin Orthop Relat Res. 2022. https://doi.org/10.1097/corr.0000000000002294.CrossRefPubMedPubMedCentral

15.

Sun L, Liu Z, Wu H, Liu B, Zhao B. Validation of the nottingham hip fracture score in predicting postoperative outcomes following hip fracture surgery. Orthop Surg. 2023. https://doi.org/10.1111/os.13624.CrossRefPubMedPubMedCentral

16.

Kkeveetil CV, Thomas G, Chander SJU. Role of micronutrients in congestive heart failure: a systematic review of randomized controlled trials. Tzu-chi Med J. 2016. https://doi.org/10.1016/j.tcmj.2016.08.001.CrossRefPubMedCentral

17.

Fisher A, Srikusalanukul W, Fisher L, Smith P. The neutrophil to lymphocyte ratio on admission and short-term outcomes in orthogeriatric patients. Int J Med Sci. 2016. https://doi.org/10.7150/ijms.15445.CrossRefPubMedPubMedCentral

18.

Wang Z, Wang H, Yang L, Jiang W, Chen X, Liu Y. High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture. Int Orthop. 2021. https://doi.org/10.1007/s00264-020-04833-1.CrossRefPubMed

19.

Marazziti D, Torrigiani S, Carbone MG, Mucci F, Flamini W, Ivaldi T, et al. Neutrophil/lymphocyte, platelet/lymphocyte, and monocyte/lymphocyte ratios in mood disorders. Curr Med Chem. 2022. https://doi.org/10.2174/0929867328666210922160116.CrossRefPubMed

20.

Caillet P, Klemm S, Ducher M, Aussem A, Schott AM. Hip fracture in the elderly: a re-analysis of the EPIDOS study with causal Bayesian networks. PLoS ONE. 2015. https://doi.org/10.1371/journal.pone.0120125.CrossRefPubMedPubMedCentral

21.

Wang Q, Zhu D. The prognostic value of systemic immune-inflammation index (SII) in patients after radical operation for carcinoma of stomach in gastric cancer. J Gastrointestin Oncol. 2019. https://doi.org/10.21037/jgo.2019.05.03.CrossRef

22.

Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021. https://doi.org/10.1186/s12877-021-02102-3.CrossRefPubMedPubMedCentral

23.

Funamizu N, Sakamoto A, Utsunomiya T, Uraoka M, Nagaoka T, Iwata M, et al. Geriatric nutritional risk index as a potential prognostic marker for patients with resectable pancreatic cancer: a single-center, retrospective cohort study. Sci Rep. 2022. https://doi.org/10.1038/s41598-022-18077-z.CrossRefPubMedPubMedCentral

24.

Guo W, Cai S, Zhang F, Shao F, Zhang G, Zhou Y, et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected non-small cell lung cancer. Thorac Cancer. 2019. https://doi.org/10.1111/1759-7714.12995.CrossRefPubMedPubMedCentral

25.

Li L, Wang H, Yang J, Jiang L, Yang J, Wu H, et al. Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep. 2018. https://doi.org/10.1038/s41598-018-30906-8.CrossRefPubMedPubMedCentral

26.

Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res Offic J Am Assoc Cancer Res. 2014. https://doi.org/10.1158/1078-0432.Ccr-14-0442.CrossRef

27.

Liu N, Lv L, Jiao J, Zhang Y, Zuo XL. Association between nutritional indices and mortality after hip fracture: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2023. https://doi.org/10.26355/eurrev_202303_31763.CrossRefPubMed

28.

Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005. https://doi.org/10.1093/ajcn/82.4.777.CrossRefPubMed

29.

Ding P, Yang P, Sun C, Tian Y, Guo H, Liu Y, et al. Predictive effect of systemic immune-inflammation index combined with prognostic nutrition index score on efficacy and prognosis of neoadjuvant intraperitoneal and systemic paclitaxel combined with apatinib conversion therapy in gastric cancer patients with positive peritoneal lavage cytology: a prospective study. Front Oncol. 2021. https://doi.org/10.3389/fonc.2021.791912.CrossRefPubMedPubMedCentral

30.

Wang Z, Tian S, Zhao K, Zhang R, Yin Y, Zhu Y, et al. Neutrophil to lymphocyte ratio and fracture severity in young and middle-aged patients with tibial plateau fractures. Int Orthop. 2020. https://doi.org/10.1007/s00264-020-04793-6.CrossRefPubMed

31.

Zhou W, Mao Z, Wang Z, Zhu H, Zhao Y, Zhang Z, et al. Diagnostic and predictive value of novel inflammatory markers of the severity of acute traumatic spinal cord injury: a retrospective study. World Neurosurg. 2023. https://doi.org/10.1016/j.wneu.2022.12.015.CrossRefPubMed

32.

Forget P, Moreau N, Engel H, Cornu O, Boland B, De Kock M, et al. The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF). Arch Gerontol Geriatr. 2015. https://doi.org/10.1016/j.archger.2014.11.008.CrossRefPubMed

33.

Galivanche AR, Kebaish KJ, Adrados M, Ottesen TD, Varthi AG, Rubin LE, et al. Postoperative pressure ulcers after geriatric hip fracture surgery are predicted by defined preoperative comorbidities and postoperative complications. J Am Acad Orthop Surg. 2020. https://doi.org/10.5435/jaaos-d-19-00104.CrossRefPubMed

34.

Mathur K, Kurbanova N, Qayyum R. Platelet-lymphocyte ratio (PLR) and all-cause mortality in general population: insights from national health and nutrition education survey. Platelets. 2019. https://doi.org/10.1080/09537104.2019.1571188.CrossRefPubMed

35.

Ding P, Guo H, Sun C, Yang P, Kim NH, Tian Y, et al. Combined systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) predicts chemotherapy response and prognosis in locally advanced gastric cancer patients receiving neoadjuvant chemotherapy with PD-1 antibody sintilimab and XELOX: a prospective study. BMC Gastroenterol. 2022. https://doi.org/10.1186/s12876-022-02199-9.CrossRefPubMedPubMedCentral

36.

Zhou J, Fu J, Zhao Q, Lin S, Zhu H. Effect of neutrophil-to-lymphocyte ratio on short-term prognosis of elderly patients with hip fracture. Am J Transl Res. 2021;13:9122.PubMedPubMedCentral

37.

He K, Si L, Pan X, Sun L, Wang Y, Lu J, et al. Preoperative systemic immune-inflammation index (SII) as a superior predictor of long-term survival outcome in patients with stage I-II gastric cancer after radical surgery. Front Oncol. 2022. https://doi.org/10.3389/fonc.2022.829689.CrossRefPubMedPubMedCentral

38.

Moldovan F, Ivanescu AD, Fodor P, Moldovan L, Bataga T. Correlation between inflammatory systemic biomarkers and surgical trauma in elderly patients with hip fractures. J Clin Med. 2023. https://doi.org/10.3390/jcm12155147.CrossRefPubMedPubMedCentral

39.

Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA, et al. Nutritional Status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018. https://doi.org/10.3390/nu10050555.CrossRefPubMedPubMedCentral

40.

Gurger M. Factors impacting 1-year mortality after hip fractures in elderly patients: a retrospective clinical study. Niger J Clin Pract. 2019. https://doi.org/10.4103/njcp.njcp_327_18.CrossRefPubMed

41.

Li S, Zhang J, Zheng H, Wang X, Liu Z, Sun T. Prognostic role of serum albumin, total lymphocyte count, and mini nutritional assessment on outcomes after geriatric hip fracture surgery: a meta-analysis and systematic review. J Arthroplast. 2019. https://doi.org/10.1016/j.arth.2019.02.003.CrossRef

42.

Fujiya K, Kawamura T, Omae K, Makuuchi R, Irino T, Tokunaga M, et al. Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol. 2018. https://doi.org/10.1245/s10434-018-6342-8.CrossRefPubMed

43.

Poziomyck AK, Weston AC, Lameu EB, Cassol OS, Coelho LJ, Moreira LF. Preoperative nutritional assessment and prognosis in patients with foregut tumors. Nutr Cancer. 2012. https://doi.org/10.1080/01635581.2012.721157.CrossRefPubMed

44.

Tsutsui T, Fujiwara T, Matsumoto Y, Kimura A, Kanahori M, Arisumi S, et al. Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures. Osteop Int J Estab Result Coop Eur Found Osteop Natl Osteop Found USA. 2023. https://doi.org/10.1007/s00198-023-06753-3.CrossRef

45.

Feliciano EMC, Kroenke CH, Meyerhardt JA, Prado CM, Bradshaw PT, Kwan ML, et al. Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer: results from the C SCANS study. JAMA Oncol. 2017. https://doi.org/10.1001/jamaoncol.2017.2319.CrossRefPubMed

46.

Wang Y, Jiang Y, Luo Y, Lin X, Song M, Li J, et al. Prognostic nutritional index with postoperative complications and 2-year mortality in hip fracture patients: an observational cohort study. Int J Surg. 2023. https://doi.org/10.1097/js9.0000000000000614.CrossRefPubMedPubMedCentral

47.

Jiang R, Li P, Shen W, Deng H, Qin C, Qiu X, et al. The predictive value of the preoperative systemic immune-inflammation index in the occurrence of postoperative pneumonia in non-small cell lung cancer: a retrospective study based on 1486 cases. Thorac cancer. 2023. https://doi.org/10.1111/1759-7714.14691.CrossRefPubMedPubMedCentral

48.

Song Y, Luo Y, Zhang F, Ma Y, Lou J, Li H, et al. Systemic immune-inflammation index predicts postoperative delirium in elderly patients after surgery: a retrospective cohort study. BMC Geriatr. 2022. https://doi.org/10.1186/s12877-022-03418-4.CrossRefPubMedPubMedCentral

49.

Wiklund R, Toots A, Conradsson M, Olofsson B, Holmberg H, Rosendahl E, et al. Risk factors for hip fracture in very old people: a population-based study. Osteop Int J Estab Result Coop Eur Found Osteop Natl Osteop Found USA. 2016. https://doi.org/10.1007/s00198-015-3390-9.CrossRef

50.

Biolo G, Cederholm T, Muscaritoli M. Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr. 2014. https://doi.org/10.1016/j.clnu.2014.03.007.CrossRefPubMedPubMedCentral

51.

Utariani A, Rahardjo E, Perdanakusuma DS. Effects of albumin infusion on serum levels of albumin, proinflammatory cytokines (TNF-α, IL-1, and IL-6), CRP, and MMP-8; tissue expression of EGRF, ERK1, ERK2, TGF-β, collagen, and MMP-8; and wound healing in sprague dawley rats. Int J Inflamm. 2020. https://doi.org/10.1155/2020/3254017.CrossRef

52.

Zhang JZ, Wang J, Qu WC, Wang XW, Liu Z, Ren JX, et al. Plasma mitochondrial DNA levels were independently associated with lung injury in elderly hip fracture patients. Injury. 2017. https://doi.org/10.1016/j.injury.2017.01.009.CrossRefPubMed

53.

Gu X, Yao Y, Wu G, Lv T, Luo L, Song Y. The plasma mitochondrial DNA is an independent predictor for post-traumatic systemic inflammatory response syndrome. PLoS ONE. 2013. https://doi.org/10.1371/journal.pone.0072834.CrossRefPubMedPubMedCentral

54.

Gan L, Zhong J, Zhang R, Sun T, Li Q, Chen X, et al. The immediate intramedullary nailing surgery increased the mitochondrial DNA release that aggravated systemic inflammatory response and lung injury induced by elderly hip fracture. Mediato Inflamm. 2015. https://doi.org/10.1155/2015/587378.CrossRef

Title: Combined Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) predict survival in elderly patients with hip fractures: a retrospective study
Authors: Ling Zhou
Chao Huang
Xianjie Zhu
Zhenhua Ma
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04585-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combined Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) predict survival in elderly patients with hip fractures: a retrospective study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Correction: Changes of improvement in upper limb function predict surgical outcome after laminoplasty in 1 year in patients with cervical spondylotic myelopathy: a retrospective study

Risk factors for malunion of distal tibia fractures treated by intramedullary nailing

Relationship between lipid metabolism, coagulation and other blood indices and etiology and staging of non-traumatic femoral head necrosis: a multivariate logistic regression-based analysis

Research on automatic recognition radiomics algorithm for early sacroiliac arthritis based on sacroiliac MRI imaging

Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele

Clinical benefits of adding dexamethasone to local infiltration analgesia for simultaneous bilateral total hip or knee arthroplasty

Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele