Combining GNRI and CLR index predicts outcome following hip fracture surgery

Hip fractures in older adults lead to high mortality and reduced quality of life, requiring effective outcome prediction tools. The Geriatric Nutritional Risk Index (GNRI) evaluates nutritional status, while inflammatory markers such as the Systemic Immune-Inflammation Index (SII), pan-immune-inflammation value (PIV), and c-reactive protein-to-lymphocyte ratio (CLR) serve as potential predictors. This study assesses the combined effectiveness of GNRI and these markers in forecasting post-hip fracture surgery outcomes.

This retrospective cohort study included geriatric hip fracture patients treated from 2020 to 2022. Biomarkers including GNRI, SII, PIV, and CLR were calculated from pre-operative laboratory data. GNRI was based on serum albumin and body weight, while inflammatory indices were derived from neutrophil, lymphocyte, platelet, monocyte counts, and CRP levels measured via hospital analyzers. Time-dependent ROC curves were used to identify optimal cutoff values, and Cox regression was applied to examine associations with overall survival.

A total of 159 patients aged ≥ 60 years were included. In single-index analyses, a high GNRI (HR 0.95, 95% CI 0.91-0.98) was significantly associated with improved overall survival (OS), while a high SII (HR 1.002, 95% CI 1.0006-1.0034) was associated with reduced OS. Combination analyses revealed that low GNRI and elevated CLR significantly associated with risk of postoperative mortality (HR 4.92, 95% CI 2.25-10.92). Combining GNRI with CLR predicted mortality within 3 months post-hip surgery with 90% accuracy.

Combining GNRI and CLR effectively predicts mortality risk in elderly hip fracture patients, particularly during the high-risk first 3 months after surgery.