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Volume 14
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10.3390/jcm14103584
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Crystal Ball in a Blood’s Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) andthe Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients

by
Andrea Perna
1,*,
Giuseppe Rovere
2,
Marco Passiatore
3,
Andrea Franchini
1,
Luca Macchiarola
1,
Francesco Maruccia
1,
Raffaele Vitiello
4 and
Franco Lucio Gorgoglione
1
1
Department of Orthopedics and Trauma Surgery, Fondazione Casa Sollievo Della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
2
Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy
3
Bone and Joint Surgery Department, University of Brescia, ASST-Spedali Civili, 25123 Brescia, Italy
4
Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(10), 3584; https://doi.org/10.3390/jcm14103584 (registering DOI)
Submission received: 29 April 2025 / Revised: 17 May 2025 / Accepted: 19 May 2025 / Published: 20 May 2025
(This article belongs to the Section Orthopedics)
Versions Notes

Abstract

Background/Objectives: Hip fractures in elderly patients are associated with high morbidity and mortality, requiring early risk stratification to optimize management. Systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools. This study aimed to evaluate the predictive value of the NLR and PLR measured at admission for adverse outcomes following hip fracture surgery in elderly patients. Methods: This retrospective, single-center cohort study included patients aged 65 years or older admitted for hip fractures between January 2019 and December 2023. Baseline demographic, clinical, surgical, and laboratory data were collected. Primary outcomes were 30-day, 90-day, and 1-year mortality; secondary outcomes included postoperative ICU admission and prolonged hospitalization (>15 days). Univariable and multivariable Cox regression analyses were performed. Receiver operating characteristic (ROC) curve analysis determined optimal cut-offs for the NLR and PLR. Results: Among 395 included patients (mean age 84 years, 56.4% female), the 30-day, 90-day, and 1-year mortality rates were 4.8%, 10.5%, and 13.9%, respectively. ROC analysis identified cut-offs of 7.2 for the NLR (AUC 0.78, sensitivity 69.7%, specificity 85.4%) and 189.4 for the PLR (AUC 0.73, sensitivity 65.1%, specificity 76.1%). Elevated NLR and PLR were independently associated with increased risk of mortality, ICU admission, and prolonged hospitalization. Conclusions: Elevated NLR and PLR at admission are independent, strong predictors of adverse outcomes in elderly patients with hip fractures. These inexpensive, readily available biomarkers could enhance early risk stratification and inform perioperative management strategies.
Keywords: hip fractures; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; PLR; NLR; elderly; mortality hip fractures; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; PLR; NLR; elderly; mortality

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MDPI and ACS Style

Perna, A.; Rovere, G.; Passiatore, M.; Franchini, A.; Macchiarola, L.; Maruccia, F.; Vitiello, R.; Gorgoglione, F.L. Crystal Ball in a Blood’s Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) andthe Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients. J. Clin. Med. 2025, 14, 3584. https://doi.org/10.3390/jcm14103584

AMA Style

Perna A, Rovere G, Passiatore M, Franchini A, Macchiarola L, Maruccia F, Vitiello R, Gorgoglione FL. Crystal Ball in a Blood’s Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) andthe Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients. Journal of Clinical Medicine. 2025; 14(10):3584. https://doi.org/10.3390/jcm14103584

Chicago/Turabian Style

Perna, Andrea, Giuseppe Rovere, Marco Passiatore, Andrea Franchini, Luca Macchiarola, Francesco Maruccia, Raffaele Vitiello, and Franco Lucio Gorgoglione. 2025. "Crystal Ball in a Blood’s Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) andthe Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients" Journal of Clinical Medicine 14, no. 10: 3584. https://doi.org/10.3390/jcm14103584

APA Style

Perna, A., Rovere, G., Passiatore, M., Franchini, A., Macchiarola, L., Maruccia, F., Vitiello, R., & Gorgoglione, F. L. (2025). Crystal Ball in a Blood’s Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) andthe Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients. Journal of Clinical Medicine, 14(10), 3584. https://doi.org/10.3390/jcm14103584

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