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Fisher A, Fisher L, Srikusalanukul W. Prediction of Osteoporotic Hip Fracture Outcome: Comparative Accuracy of 27 Immune-Inflammatory-Metabolic Markers and Related Conceptual Issues. J Clin Med 2024; 13:3969. [PMID: 38999533 PMCID: PMC11242639 DOI: 10.3390/jcm13133969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Objectives: This study, based on the concept of immuno-inflammatory-metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF patient (n = 1273, mean age 82.9 ± 8.7 years, 73.5% females) demographics, medical history, laboratory parameters, and outcomes were recorded prospectively. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were used to establish the predictive role for each biomarker. Results: Among 27 IIM biomarkers, 10 indices were significantly associated with development of PMI and 16 were indicative of a fatal outcome; in the subset of patients aged >80 years with ischaemic heart disease (IHD, the highest risk group: 90.2% of all deaths), the corresponding figures were 26 and 20. In the latter group, the five strongest preoperative predictors for PMI were anaemia (AUC 0.7879), monocyte/eosinophil ratio > 13.0 (AUC 0.7814), neutrophil/lymphocyte ratio > 7.5 (AUC 0.7784), eosinophil count < 1.1 × 109/L (AUC 0.7780), and neutrophil/albumin × 10 > 2.4 (AUC 0.7732); additionally, sensitivity was 83.1-75.4% and specificity was 82.1-75.0%. The highest predictors of in-hospital death were platelet/lymphocyte ratio > 280.0 (AUC 0.8390), lymphocyte/monocyte ratio < 1.1 (AUC 0.8375), albumin < 33 g/L (AUC 0.7889), red cell distribution width > 14.5% (AUC 0.7739), and anaemia (AUC 0.7604), sensitivity 88.2% and above, and specificity 85.1-79.3%. Internal validation confirmed the predictive value of the models. Conclusions: Comparison of 27 IIM indices in HF patients identified several simple, widely available, and inexpensive parameters highly predictive for PMI and/or in-hospital death. The applicability of IIM biomarkers to diagnose and predict risks for chronic diseases, including OP/OF, in the preclinical stages is discussed.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Medical School, Australian National University, Canberra 2601, Australia
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
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Kim HJ, Kim HS, Heo JH. Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture. J Pers Med 2024; 14:673. [PMID: 39063927 PMCID: PMC11278238 DOI: 10.3390/jpm14070673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Femoral fractures often lead to complications such as altered pulmonary hemodynamics. Right ventricular global longitudinal strain (RV GLS), which correlates with pulmonary hemodynamics, indicates the subclinical function of the right ventricle (RV). This study aimed to investigate the predictive value of RV GLS for the risk of adverse clinical composite outcomes in patients with femoral fractures. METHODS Data were obtained from a prospective single-center cohort of patients hospitalized for femoral fractures and followed up for at least 1 year between March 2021 and October 2022. The primary outcome was the development of an adverse composite clinical event, which included pneumonia, pulmonary oedema or effusion, pulmonary thromboembolism, and all-cause mortality within the 1-year period following surgery. RESULTS Among the 163 patients, 36 (22.09%) experienced adverse composite clinical events during 1-year follow-up. The adverse outcome group demonstrated poorer RV GLS and RV free wall strain values than the non-adverse outcome group. The optimal cut-off value of RV GLS for predicting composite adverse clinical events was -12.55%. The cumulative composite event-free survival rate was significantly lower in the RV GLS ≥ -12.55% group (log-rank p-value = 0.003). After adjusting for confounding factors, multivariate Cox proportional hazards regression analyses showed that RV GLS ≥ -12.55% independently increased the risk of composite adverse clinical events by 2.65-fold. CONCLUSIONS Poor RV GLS is a significant predictor of adverse clinical outcomes in patients with femoral fractures. Specifically, an RV GLS value of ≥ -12.55% indicated a substantially increased risk of adverse events.
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Affiliation(s)
- Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Republic of Korea
| | - Hyun-Sun Kim
- Department of Nursing, College of Nursing, Eulji University, 712 Dongil-ro, Uijeongbu 11759, Republic of Korea
| | - Jeong-Heon Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Republic of Korea
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Liu ZJ, Li GH, Wang JX, Mo ZH, Yang KY, Shen CL, Shen ZX. Prognostic value of the systemic immune-inflammation index in critically ill elderly patients with hip fracture: evidence from MIMIC (2008-2019). Front Med (Lausanne) 2024; 11:1408371. [PMID: 38873200 PMCID: PMC11169710 DOI: 10.3389/fmed.2024.1408371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Background The systemic immune-inflammation index (SII) showed an extensive link between immunological dysfunction and the activation of systemic inflammation. Several studies have confirmed the application of SII to orthopedic diseases. However, the significance of SII in critically ill elderly individuals with hip fracture who require intensive care unit (ICU) admission is not yet known. This study centered on exploring the relationship between SII and clinical outcomes among critically ill elderly hip fracture individuals. Methods The study centered around elderly patients experiencing severe illness following hip fractures and requiring admission to the ICU. These patients from the MIMIC-IV database formed the basis of this study's cohort. We stratified them into quartiles according to their SII levels. The results involved the mortality at 30 days and 1 year post-admission. Then we employ Cox proportional hazards regression analysis as well as restricted cubic splines to explore the association between the SII and clinical results in critically ill elderly patients with hip fracture. Results The study encompassed 991 participants, among whom 63.98% identified as females. Notably, the mortality rates attributed to any cause within 30 days and 1 year after hospitalization stood at 19.68 and 33.40%, respectively. The multivariate Cox proportional hazards model disclosed a significant correlation between an elevated SII and all-cause mortality. Following adjustments for confounding variables, individuals with a high SII showed a notable correlation with 30-day mortality [adjusted hazard ratio (HR), 1.065; 95% confidence interval (CI), 1.044-1.087; p < 0.001] and 1-year mortality (adjusted HR, 1.051; 95% CI, 1.029-1.074; p < 0.001). Furthermore, the analysis of restricted cubic splines demonstrated a progressive increase in the risk of all-cause death as the SII value rose. Conclusion Among critically ill elderly patients with hip fracture, the SII exhibits a non-linear association that positively correlates with both 30-day and 1-year all-cause mortality rates. The revelation indicates that the SII may play a vital role in identifying patients with hip fractures who face an escalated risk of mortality due to any cause.
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Affiliation(s)
- Zhen-Jiang Liu
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Gen-He Li
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Jing-Xuan Wang
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Zhi-Hong Mo
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Kang-Yong Yang
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Chu-Long Shen
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Zhao-Xiong Shen
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
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Yilmaz S, Kurt M, Dülgeroğlu TC. Investigation of the predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality in patients with endoprosthesis after hip fracture. Medicine (Baltimore) 2024; 103:e38063. [PMID: 38701306 PMCID: PMC11062679 DOI: 10.1097/md.0000000000038063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
In this research, we aimed to investigate the predictive value of the systemic immune inflammation index and prognostic nutritional index on mortality among patients with an endoprosthesis after a hip fracture. In this retrospective, cross-sectional study, a total of 915 patient files applied to our hospital between 2020 and 2023 with an endoprosthesis after a hip fracture were subjected to the study. The patients were divided into 2 groups: alive (n = 396; 43.3%) and deceased (n = 519; 56.7%). The eosinophil-to-lymphocyte ratio, hemoglobin-to-red cell distribution width ratio (HRR), mean platelet volume-to-platelet ratio (MPVPR), neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, monocyte-to-eosinophil ratio (MER), neutrophile-to-monocyte ratio, systemic inflammation index (SII), and prognostic nutritional index (PNI) parameters of the patients were evaluated. The mortality rate was higher among male patients, with a statistically significant difference (P < .05). The follow-up duration, albumin, HGB, eosinophil, lymphocyte, eosinophil %, eosinophil-to-lymphocyte ratio, HRR, and PNI means were significantly higher in the living group (P < .05). Age, MPV, MPVPR, neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, MER, and systemic inflammation index were significantly higher in the deceased group (P < .05). The predictive value of gender (B = -0.362; P < .01), age (B = 0.036; P < .01), HRR (B = -1.100; P < .01), MPVPR (B = 8.209; P < .01), MER (B = 0.006; P < .01), and PNI (B = -0.078; P < .01) were statistically significant at the multivariate level. The time of death was significantly predicted by gender (B = 0.10; P < .05), age (B = -0.02; P < 0 = 1), HRR (B = 0.61; P < .01), MPVPR (r = -4.16; P < .01), MER (B = -0.01; P < .05), and PNI (B = 0.03; P < .01). The predictive value of PNI for the 30-day mortality rate was statistically significant (AUC: 0.643; P < .01). For a PNI cutoff value of 34.475, sensitivity was 69.7%, and specificity was 51.1%. The PNI has predictive value both in estimating overall mortality and in predicting the 30-day mortality rates among patients undergoing endoprosthesis after a hip fracture.
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Affiliation(s)
- Selçuk Yilmaz
- Department of Orthopedics and Traumatology, Antalya City Hospital, Antalya, Turkey
| | - Mehmet Kurt
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Turan Cihan Dülgeroğlu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
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Tabata T, Yagi M, Suzuki S, Takahashi Y, Ozaki M, Tsuji O, Nagoshi N, Matsumoto M, Nakamura M, Watanabe K. Dysregulation of Inflammatory Pathways in Adult Spinal Deformity Patients with Frailty. J Clin Med 2024; 13:2294. [PMID: 38673567 PMCID: PMC11051152 DOI: 10.3390/jcm13082294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: An important aspect of the pathophysiology of frailty seems to be the dysregulation of inflammatory pathways and the coagulation system. However, an objective assessment of the impact of frailty on the recovery from surgery is not fully studied. This study sought to assess how frailty affects the recovery of adult spinal deformity (ASD) surgery using blood biomarkers. Methods: 153 consecutive ASD patients (age 64 ± 10 yr, 93% female) who had corrective spine surgery in a single institution and reached 2y f/u were included. The subjects were stratified by frailty using the modified frailty index-11 (robust [R] group or prefrail and frail [F] group). Results of commonly employed laboratory tests at baseline, 1, 3, 7, and 14 post-operative days (POD) were compared. Further comparison was performed in propensity-score matched-39 paired patients between the groups by age, curve type, and baseline alignment. A correlation between HRQOLs, major complications, and biomarkers was performed. Results: Among the propensity-score matched groups, CRP was significantly elevated in the F group at POD1,3(POD1; 5.3 ± 3.1 vs. 7.9 ± 4.7 p = 0.02, POD3; 6.6 ± 4.6 vs. 8.9 ± 5.2 p = 0.02). Transaminase was also elevated in the F group at POD3(ASD: 36 ± 15 vs. 51 ± 58 U/L, p = 0.03, ALT: 32 ± 16 vs. 47 ± 55 U/L, p = 0.04). Interestingly, moderate correlation was observed between transaminase at POD1 and 2 y SRS22 (AST; function r = -0.37, mental health r = -0.39, satisfaction -0.28, total r = -0.40, ALT; function r = -0.37, satisfaction -0.34, total r = -0.39). Conclusions: Frailty affected the serum CRP and transaminase differently following ASD surgery. Transaminase at early POD was correlated with 2 y HRQOLs. These findings support the hypothesis that there is a specific physiological basis to the frailty that is characterized in part by increased inflammation and that these physiological differences persist.
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Affiliation(s)
- Tomohisa Tabata
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Otawara 324-8501, Japan
- International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masahiro Ozaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Schiavi P, Pogliacomi F, Bergamaschi M, Ceccarelli F, Vaienti E. Evaluation of Outcome after Total Hip Arthroplasty for Femoral Neck Fracture: Which Factors Are Relevant for Better Results? J Clin Med 2024; 13:1849. [PMID: 38610614 PMCID: PMC11012496 DOI: 10.3390/jcm13071849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Femoral neck fractures (FNFs) are frequent orthopedic injuries in elderly patients. Despite improvements in clinical monitoring and advances in surgical procedures, 1-year mortality remains between 15% and 30%. The aim of this study is to identify variables that lead to better outcomes in patients treated with total hip arthroplasty (THA) for FNFs. Methods: All patients who underwent cementless THA for FNF from January 2018 to December 2022 were identified. Patients aged more than 80 years old and with other post-traumatic lesions were excluded. Patient data and demographic characteristics were collected. The following data were also registered: time trauma/surgery, surgical approach, operative time, intraoperative complications, surgeon arthroplasty-trained or not, and anesthesia type. In order to search for any predictive factors of better short- and long-term outcomes, we performed different logistic regression analyses. Results: A total of 92 patients were included. From multivariable logistic regression models, we derived that a direct anterior surgical approach and an American Society of Anesthesiologists (ASA) classification < 3 can predict improved short-term outcomes. Moreover, THAs performed by surgeons with specific training in arthroplasty have a lower probability of revision at 1 year. Mortality at 1 year was ultimately influenced by the ASA classification. Conclusions: A direct anterior approach and specific arthroplasty training of the surgeon appear to be able to improve the short- and long-term follow-up of THA after FNF.
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Affiliation(s)
- Paolo Schiavi
- Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (M.B.); (F.C.); (E.V.)
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Zhou L, Huang C, Zhu X, Ma Z. Combined Systemic Immune-inflammatory Index (SII) and Geriatric Nutritional Risk Index (GNRI) predict survival in elderly patients with hip fractures: a retrospective study. J Orthop Surg Res 2024; 19:125. [PMID: 38321497 PMCID: PMC10845798 DOI: 10.1186/s13018-024-04585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
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.
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Affiliation(s)
- Ling Zhou
- Graduate School of Dalian Medical University, Dalian, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Chao Huang
- Department of Orthopaedic Surgery, People's Hospital of Rizhao, Rizhao, China
| | - Xianjie Zhu
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Zhenhua Ma
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China.
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Moldovan F. Sterile Inflammatory Response and Surgery-Related Trauma in Elderly Patients with Subtrochanteric Fractures. Biomedicines 2024; 12:354. [PMID: 38397956 PMCID: PMC10887083 DOI: 10.3390/biomedicines12020354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Sterile inflammation is a natural response of the organism in the absence of microorganisms, which is triggered in correspondence with the degree of tissue damage sustained after a surgical procedure. The objective of this study was to explore the values of postoperative hematological-derived biomarkers in assessing the sterile inflammatory response magnitude related to the invasiveness of the surgical reduction technique used for subtrochanteric fractures (STFs) treatment. A retrospective, observational cohort research was conducted between January 2021 and October 2023 that included a total of 143 patients diagnosed with acute subtrochanteric fractures who underwent long Gamma Nail (LGN) fixation. According to the surgical reduction technique used, they were divided into two groups: group 1, which consisted of those with a closed reduction and internal fixation (CRIF); and group 2, which consisted of those with an open reduction internal fixation (ORIF). Between groups, statistically significant differences (p < 0.05) were found in relation to days to surgery, length of hospital stay (LOHS), duration of surgery, postoperative hemoglobin (HGB) levels, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The receiver operating characteristics (ROC) curve analysis revealed that all ratios presented a high diagnostic ability (p < 0.0001) with NLR > 6.95 being the most reliable (sensitivity 94.8% and specificity 70.6%). Moreover, the multivariate regression model confirmed that sterile immune response after orthopedic interventions can be assessed in an almost equal and non-dependent manner using these biomarkers. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated to the sterile inflammatory response magnitude, due to the extent of surgical dissection performed during internal fixation procedures of subtrochanteric femur fractures.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Al-Husinat L, Al Sharie S, Araydah M, Al Modanat Z, Ismail MIA, Heilat HB, Dawod MS, Sawaftah KA, De Rosa S, Battaglini D. Clinical Characteristics of Spinal versus General Anaesthesia in Older Patients Undergoing Hip Fracture Repair Surgery in Jordan: A Multicentre Study. J Pers Med 2023; 13:1611. [PMID: 38003926 PMCID: PMC10672458 DOI: 10.3390/jpm13111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The primary aim of this study was to examine the clinical characteristics and outcomes of older patients who underwent hip fracture repair surgery. The secondary aims were to assess the predictors of the choice of spinal or general anaesthesia and to explore the risk factors for all-cause mortality. METHODS This three-tertiary centres study was conducted at a tertiary care centre in Jordan. Clinical data include previous fracture history; medication details; comorbidities; surgical approach; and postoperative pain management. RESULTS Overall, 1084 patients who underwent hip fracture repair were included in this study. The mean age of patients was 78 years, and 55.2% were women. Twenty-four were treated with bisphosphonates before the fracture, whereas 30 were in steroid therapy. Overall, 61.8% of patients underwent spinal anaesthesia, whereas 38.2% underwent general anaesthesia. Spinal anaesthesia group had a lower prevalence of cardiovascular accidents (16.3% vs. 22.3%, p = 0.014) and Alzheimer's (3.4% vs. 1.4%, p = 0.049) than the general anaesthesia group. In the spinal anaesthesia group, postoperative opioid administration (p = 0.025) and postoperative blood transfusion (p = 0.011) occurred more frequently than general anaesthesia group. In hospital, 30-day and all-cause mortality were comparable between both groups. Diabetes mellitus (HR = 2.6; 95%CI = 1.5-4.4; p = 0.001); cemented hip hemiarthroplasty (HR = 2.4; 95%CI = 1.1-5.1; p = 0.025); deep venous thrombosis/pulmonary embolism (HR = 5.0; 95%CI = 1.2-12.9; p = 0.001); and readmission within 1 month from surgery (HR = 3.6; 95%CI = 2.0-6.3; p < 0.001) were all significant predictors of mortality. CONCLUSIONS This study provides insights into the outcomes and factors associated with different anaesthesia types in hip fracture repair surgery. The anaesthesia type does not affect all-cause mortality in patients undergoing hip fracture repair.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (Z.A.M.); (H.B.H.)
| | - Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Mohammad Araydah
- Department of Internal Medicine, Istishari Hospital, Amman 11942, Jordan;
| | - Zaid Al Modanat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (Z.A.M.); (H.B.H.)
| | | | - Hadeel B. Heilat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (Z.A.M.); (H.B.H.)
| | - Mohd Said Dawod
- Department of Special Surgery, College of Medicine, Mutah University, Al-Karak 61710, Jordan;
| | | | - Silvia De Rosa
- Centre for Medical Sciences—CISMed, University of Trento, 38122 Trento, Italy;
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
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Rau CS, Kuo SCH, Tsai CH, Chou SE, Su WT, Hsu SY, Hsieh CH. Elevation of White Blood Cell Subtypes in Adult Trauma Patients with Stress-Induced Hyperglycemia. Diagnostics (Basel) 2023; 13:3451. [PMID: 37998587 PMCID: PMC10670758 DOI: 10.3390/diagnostics13223451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Blood immune cell subset alterations following trauma can indicate a patient's immune-inflammatory status. This research explored the influence of stress-induced hyperglycemia (SIH) on platelet counts and white blood cell (WBC) subtypes, including the derived indices of the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in trauma patients. METHODS We studied 15,480 adult trauma patients admitted from 1 January 1998 to 31 December 2022. They were categorized into four groups: nondiabetic normoglycemia (NDN, n = 11,602), diabetic normoglycemia (DN, n = 1750), SIH (n = 716), and diabetic hyperglycemia (DH, n = 1412). A propensity score-matched cohort was formed after adjusting for age, sex, and comorbidities, allowing for comparing the WBC subtypes and platelet counts. RESULTS Patients with SIH exhibited significantly increased counts of monocytes, neutrophils, and lymphocytes in contrast to NDN patients. However, no significant rise in platelet counts was noted in the SIH group. There were no observed increases in these cell counts in either the DN or DH groups. CONCLUSIONS Our results demonstrated that trauma patients with SIH showed significantly higher counts of monocytes, neutrophils, and lymphocytes when compared to NDN patients, whereas the DN and DH groups remained unaffected. This underscores the profound association between SIH and elevated levels of specific WBC subtypes.
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Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan;
| | - Spencer Chia-Hao Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan;
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan; (C.-H.T.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan; (C.-H.T.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan; (C.-H.T.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan; (C.-H.T.); (S.-E.C.); (W.-T.S.); (S.-Y.H.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City 83301, Taiwan;
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Domagalska M, Reysner T, Kowalski G, Daroszewski P, Mularski A, Wieczorowska-Tobis K. Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty-A Prospective, Randomised, Double-Blinded Clinical Trial. J Clin Med 2023; 12:7088. [PMID: 38002702 PMCID: PMC10672046 DOI: 10.3390/jcm12227088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adductor canal block (ACB) in total knee arthroplasty (TKA). PATIENTS AND METHODS This was a prospective, double-blinded, randomised, controlled trial in a tertiary referral hospital. Three hundred and sixty-six patients were randomly allocated into the sham block group and iPACK combined with the ACB group. The primary outcome was postoperative pain scores. The secondary outcomes were opioid consumption, functional recovery expressed by a range of motion, and quadriceps strength. Also, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. RESULTS There were significant differences between the sham block and iPACK + ACB group in pain scores p < 0.0001 at all time points. Therefore, there was a significant difference in opioid consumption (p < 0.0001) and functional recovery (p < 0.0001). Also, NLR and PLR levels 12 h (p < 0.0001) and 24 h (24 h) after surgery (p < 0.0001) were much lower in the iPACK + ACB group. CONCLUSION After total knee arthroplasty, the iPACK combined with ACB block group improved pain management, functional recovery, and stress response. Therefore, we strongly recommend this technique as a part of a multimodal analgesia protocol in knee surgery.
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Affiliation(s)
- Malgorzata Domagalska
- Department of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, Poland
| | - Tomasz Reysner
- Department of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, Poland
| | - Grzegorz Kowalski
- Department of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, Poland
| | - Przemysław Daroszewski
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, 61-545 Poznań, Poland
| | - Aleksander Mularski
- Department of Forensic Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland
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12
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Regenbogen S, Leister I, Trulson A, Wenzel L, Friederichs J, Stuby FM, Höch A, Beck M. Early Stabilization Does Not Increase Complication Rates in Acetabular Fractures of the Elderly: A Retrospective Analysis from the German Pelvis Registry. J Clin Med 2023; 12:7043. [PMID: 38002658 PMCID: PMC10672727 DOI: 10.3390/jcm12227043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Background: The incidence of acetabular fractures in geriatric patients has increased. Although there are strong data supporting the early operative treatment of hip fractures in geriatric patients, the optimal timing for acetabular fractures remains unclear and for several reasons, delayed treatment after trauma is common. Methods: A retrospective analysis of the German Pelvis Registry between 2008 and 2017 was performed. Ultimately, 665 patients with fractures of the anterior column or anterior column and posterior hemitransverse were enrolled. Patients above and below 65 years of age with these fracture types were analyzed regarding surgery day (within 48 hours, between 2 and 4 days, after 4 days), complication rate, reduction quality, and hospital stay. Results: The complication rate of the geriatric group was twice as high as that of younger patients; however, this finding was independent of the timing of surgery. Reduction quality and hospital stay were independent of surgical timing. Conclusions: In contrast to other fracture types, such as proximal femur fractures, the timing of surgery for acetabular fractures does not have a significant impact on the patient's outcome. The optimal time for surgery cannot be determined using the current data. However, as expected, there is a significantly higher risk for postoperative complications in the geriatric population.
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Affiliation(s)
- Stephan Regenbogen
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany; (S.R.); (A.T.); (L.W.); (J.F.); (F.M.S.)
- Department of Traumatology, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Iris Leister
- Spinal Cord Injury Center, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany;
| | - Alexander Trulson
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany; (S.R.); (A.T.); (L.W.); (J.F.); (F.M.S.)
| | - Lisa Wenzel
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany; (S.R.); (A.T.); (L.W.); (J.F.); (F.M.S.)
| | - Jan Friederichs
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany; (S.R.); (A.T.); (L.W.); (J.F.); (F.M.S.)
| | - Fabian M. Stuby
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany; (S.R.); (A.T.); (L.W.); (J.F.); (F.M.S.)
| | - Andreas Höch
- Department for Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany;
| | - Markus Beck
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, 82418 Murnau, Germany; (S.R.); (A.T.); (L.W.); (J.F.); (F.M.S.)
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13
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Alsabani MH, Alotaibi BA, Olayan LH, Alghamdi AS, Alshammasi MA, Alqasir BA, Alrashidi SM, Alshugair MS, Al Harbi MK. The Value of Preoperative Systemic Immune-Inflammation Index as a Predictor of Prolonged Hospital Stay in Orthopedic Surgery: A Retrospective Study. Int J Gen Med 2023; 16:4773-4782. [PMID: 37904903 PMCID: PMC10613446 DOI: 10.2147/ijgm.s434630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Purpose Many risk factors, such as the duration of surgery and higher ASA scores, are associated with longer hospitalization in patients undergoing orthopedic surgery. However, no studies have evaluated the relationship between the preoperative systemic immune-inflammation index (SII) and length of hospital stay in orthopedic surgical patients. Therefore, this study aimed to investigate whether the SII is associated with the length of hospital stay in orthopedic surgery in adults. Patients and Methods This was a retrospective cohort study, and data were extracted from electronic health records. Patients were included if they were older than 18 years and had undergone orthopedic surgery between [2016-2021]. The patients were divided into two groups according to the median duration of hospitalization and according to SII cut-off value (high-SII group: ≥799.86, low-SII group: <799.86). Univariate and multivariate linear regression analyses were used to identify the association between SII and length of hospitalization. Results A total of 196 patients who underwent orthopedic surgery were included, and 62 were hospitalized for >21 days. There were significant differences in terms of ASA score (P = 0.041). Patients who required a longer hospitalization of >21 days had significantly lower hemoglobin level (P < 0.001), higher duration of surgery (P = 0.015), and increased requirement of ICU admission (P < 0.001). The optimal cut-off value for preoperative SII of 799.86 stratified the patients into high-SII and low-SII groups. Patients in high-SII group had higher median LOHS (22 days) compared to low-SII group (17 days; P = 0.006). In the multivariable linear regression analysis, the SII was significantly related to the length of hospital stay (β = 0.246, 95% confidence interval [CI] 0.000-0.005, P = 0.031). Conclusion A high-SII value is associated with an increased risk of longer hospitalization after orthopedic surgery.
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Affiliation(s)
- Mohmad H Alsabani
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Badi A Alotaibi
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lafi H Olayan
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Abdulrhman S Alghamdi
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Malik A Alshammasi
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bassam Abdulrahman Alqasir
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salman Madyan Alrashidi
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Majed Saad Alshugair
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed K Al Harbi
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Moldovan F. Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties-Clinical Considerations Supported by Case Studies. J Pers Med 2023; 13:1381. [PMID: 37763149 PMCID: PMC10532717 DOI: 10.3390/jpm13091381] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Severe symptoms such as hypoxemia, hypotension, and unexpected loss of consciousness may develop during surgical interventions that use polymethyl methacrylate (PMMA), or as it is commonly known, bone cement. Physicians recognize this amalgam of clinical manifestations more and more as a distinct entity that bears the name of bone cement implantation syndrome (BCIS). Trauma cases, especially hip fractures, are seen to have a higher incidence of developing this complication compared to orthopedic elective ones. This research aims to present a detailed description of six severe BCIS cases in order to raise awareness and to emphasize its importance. Five of them had fatal outcomes, which demonstrate the necessity of future research on this topic, as little is known about it presently. In the Discussion section, a narrative overview from the scientific literature is performed on potential risk factors, prevention measures, and management strategies. The experience gathered through this case series may aid medical staff in the development of diagnostic and therapeutic protocols, thus improving safety when cemented surgical techniques are used on a high-risk group of patients.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Alshuweishi Y, Alfaifi M, Almoghrabi Y, Al-Sheikh YA, Alfhili MA. A Retrospective Analysis of the Association of Neutrophil-Lymphocyte Ratio (NLR) with Anemia in the Saudi Population. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1592. [PMID: 37763711 PMCID: PMC10536447 DOI: 10.3390/medicina59091592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Background: The link between inflammation and anemia is well established but fluctuations in the emerging inflammatory index, neutrophil-lymphocyte ratio (NLR), in anemic subjects remain ambiguous. The purpose of this study is to address the prevailing knowledge gaps regarding the association of NLR with anemia in the Saudi population. Methods: Laboratory results of NLR, C-reactive protein (CRP), and hemoglobin for 14,261 subjects were obtained from Al Borg Diagnostics and retrospectively analyzed. Means, risk measures, and the diagnostic performance of NLR for anemia were examined in age- and gender-wise comparisons. Results: NLR was significantly elevated in anemic individuals and those with high NLR had a significantly lower Hb concentration. Moreover, elevated NLR was more prevalent in anemic subjects (PR: 1.87, 95% CI: 1.46-2.40, p < 0.0001) and carried a greater risk for the condition (OR: 1.91, 95% CI: 1.47-2.48, p < 0.0001) as did CRP. These observations demonstrated distinct age- and gender-specific patterns. However, both parameters were of no value in the diagnosis of anemia as seen from receiver operating characteristic curves. Conclusions: Altogether, these findings indicate that elevated NLR is associated with anemia, which suggests its usefulness for monitoring rather than diagnosing anemia associated with inflammation in Saudi subjects. Further examination of this association in longitudinal studies is needed.
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Affiliation(s)
- Yazeed Alshuweishi
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia; (Y.A.); (Y.A.A.-S.)
| | - Mohammed Alfaifi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia;
| | - Yousef Almoghrabi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Clinical Pathology, Al Borg Diagnostics, Jeddah 23226, Saudi Arabia
| | - Yazeed A. Al-Sheikh
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia; (Y.A.); (Y.A.A.-S.)
| | - Mohammad A. Alfhili
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia; (Y.A.); (Y.A.A.-S.)
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Koutserimpas C, Kotzias D, Chronopoulos E, Naoum S, Raptis K, Karamitros A, Dretakis K, Piagkou M. Suggestion of a Novel Classification Based on the Anatomical Region and Type of Bilateral Fatigue Femoral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1572. [PMID: 37763691 PMCID: PMC10534755 DOI: 10.3390/medicina59091572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Purpose: Bilateral fatigue femoral fractures (BFFF) represent an extremely rare clinical entity. The present study introduces a novel classification, in order to categorize the BFFFs and provide a thorough review of all these, so far in the literature, reported cases. Methods: The BFFF were classified taking into account the anatomical region of the femoral fracture; (fh): femoral head, (sc): sub-capital, (pt): peri-trochanteric, (st): sub-trochanteric, (s): shaft, (d): distal femur and the fracture type (complete or incomplete); type I: bilateral incomplete fractures, type II: unilateral incomplete fracture, and type III: bilateral complete fractures. Type III was further subdivided into type IIIA: bilateral non-displaced fractures, type IIIB: unilateral displaced fracture, and type IIIC: bilateral displaced fractures. Furthermore, a meticulous review of the PubMed and MEDLINE databases was conducted to locate all articles reporting these injuries. Results: A total of 38 patients (86.8% males), with a mean age of 25.3 years, suffering BFFFs were identified from the literature search. The mean time interval from symptoms' onset to diagnosis was 54 days. According to the proposed classification, 2.6% of the fractures were categorized as type I (h), 36.8% as type I (sc), 2.6% as type I(st/s), 7.9% as type I (s), 2.6% as type I (d), 5.4% as type II (fh), 26.3% as type II (sc), 2.6% as type IIIA (st), 2.6% as type IIIA (d), 5.4% as type IIIB (sc), 2.6% as type IIIB (d) and 2.6% as type IIIC (sc). Surgery was performed in 52.6%, while non-operative treatment was followed in 47.4% of the population. Regarding the fracture type, 75% of type I fractures were conservatively treated, while 91.7% and 66.6% of type II and III fractures were surgically treated. For patients treated conservatively, the mean time from diagnosis to return to previous status was 260 days, while for patients treated surgically, 343 days. Conclusions: BFFFs, although rare, may pose a diagnostic and therapeutic challenge. The present classification offers valuable information and may act as a guide for the management of these patients.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 15123 Athens, Greece;
| | - Dimitrios Kotzias
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Efstathios Chronopoulos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 14561 Athens, Greece;
| | - Symeon Naoum
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Athanasios Karamitros
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (D.K.); (S.N.); (K.R.); (A.K.)
| | - Konstantinos Dretakis
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 15123 Athens, Greece;
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Albayrak H. Neutrophil-to-Lymphocyte Ratio, Neutrophil-to-Monocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immune-Inflammation Index in Psoriasis Patients: Response to Treatment with Biological Drugs. J Clin Med 2023; 12:5452. [PMID: 37685519 PMCID: PMC10488109 DOI: 10.3390/jcm12175452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated skin disease in which systemic inflammation plays an important role in its pathogenesis. In recent years, the neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were shown to be important indicators of inflammation. This study aimed to investigate the NLR, NMR, PLR, and SII levels in psoriasis patients treated with biological agents. METHOD Clinical and biochemical data of 209 patients who received systemic therapy for psoriasis were obtained by retrospectively reviewing their medical records. The NLR, NMR, PLR, and SII values were calculated from the hemogram values of the patients. RESULTS In the third month of follow-up, the mean CRP, NLR, NMR, PLR, and SII values were significantly decreased compared with the baseline values. The SII values showed strong positive correlations with the NLR, NMR, and PLR. Adalimumab, etanercept, and infliximab, which are TNF-α blockers, were observed to be more effective on the PLR and NLR, and especially the NMR. CONCLUSIONS The NLR, NMR, PLR, and SII, which are data derived from routine blood tests, can be used in the monitoring of the treatment of psoriasis, especially with TNF-α blockers.
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Affiliation(s)
- Hulya Albayrak
- Dermatology Department, Faculty of Medicine, Namık Kemal University, Tekirdağ 59030, Turkey
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