German Congress of Orthopaedics and Traumatology (DKOU 2025)
The significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-leukocyte ratio (PLR) in predicting postoperative delirium among elderly patients with hip fracture
2Hubei Clinical Medical Research Center of Trauma and Microsurgery, Wuhan, China
3Elderly Hip Fracture Diagnosis and Treatment Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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Objectives and questions: The primary objective of this study was to investigate the effects of the preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-white blood cell ratio (PWR) on elderly patients undergoing surgery for hip fractures, specifically regarding their predictive value for the risk of subsequent delirium.
Material and methods: This study employed a retrospective analysis method. Receiver operating characteristic curve analysis was utilized to evaluate the predictive ability of preoperative NLR and PWR or postoperative delirium and to determine their optimal cutoff values. Patients were categorized into a delirium group and a no-delirium group based on the development of delirium post-surgery for comparative analysis. Initially, univariate analysis was conducted to identify factors associated with postoperative delirium, followed by multiple logistic regression analysis to ascertain their independent risk factors.
Results: Research findings indicate that among elderly patients with hip fractures who underwent surgery, the incidence of postoperative delirium was 12.69%. ROC curve analysis showed that both NLR and PWR had high sensitivity and specificity as predictors of postoperative delirium, with the optimal cutoff point for NLR being 11.53, sensitivity at 85.70%, specificity at 90.30%, and an area under the curve of 0.91; for PWR, the optimal cutoff point was 18.18, with sensitivity at 69.00%, specificity at 70.90%, and an area under the curve of 0.71. Multivariate logistic regression analysis further confirmed that elevated NLR (OR, 1.44; 95% CI, 1.24–1.65; P = 0.000) and decreased PWR (OR, 0.89; 95% CI, 0.81–0.98; P = 0.000) are independent risk factors for postoperative delirium.
Discussion and conclusions: The study concluded that a preoperative NLR greater than 11.53 and a PWR less than 18.18 can serve as predictors of postoperative delirium in elderly patients with hip fractures.
