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Prognostic Value of HALP Score, PNI, and SII in Predicting 1-Year Mortality in Geriatric Femoral Fractures: A 5-Year
Hasan Mansur Durgun1, Emin Özkul2, Mahmut Yaman1
1Department of Emergency Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
BACKGROUND With the global rise in geriatric populations, femoral fractures in elderly individuals have become a major health burden. This study aimed to evaluate the prognostic value of 3 readily available laboratory-based indices - HALP (hemoglobin, albumin, lymphocyte, platelet), Prognostic Nutritional Index (PNI), and Systemic Immune-Inflammation Index (SII) - in predicting 1-year mortality among elderly patients with femoral fractures. MATERIAL AND METHODS This retrospective cohort study included 309 patients aged ≥65 years who presented to the emergency department of a tertiary university hospital between 2018 and 2023 with low-energy femoral fractures and who underwent surgery. Demographic, clinical, and laboratory data were collected. HALP, PNI, and SII were calculated preoperatively. In-hospital, 30-day, and 1-year mortality were recorded. ROC analysis was used to assess the predictive accuracy of each index. RESULTS One-year mortality was 32.4%, while in-hospital and 30-day mortality were 5.5% and 11%, respectively. Lower albumin and PNI scores were significantly associated with higher mortality at all time points (P<0.001). PNI demonstrated moderate predictive accuracy (AUC=0.659), while HALP had limited but statistically significant predictive value (AUC=0.577, P=0.030). SII did not show statistically significant prognostic value (AUC=0.549, P=0.166). Multivariate analysis showed PNI and HALP are independent predictors of long-term mortality. CONCLUSIONS PNI and HALP are practical, cost-effective tools with prognostic utility in elderly patients with femoral fractures. Early identification of high-risk individuals using these biomarkers may facilitate targeted interventions and improved outcomes. Future multicenter prospective studies are warranted for external validation.
BACKGROUND With the global rise in geriatric populations, femoral fractures in elderly individuals have become a major health burden. This study aimed to evaluate the prognostic value of 3 readily available laboratory-based indices - HALP (hemoglobin, albumin, lymphocyte, platelet), Prognostic Nutritional Index (PNI), and Systemic Immune-Inflammation Index (SII) - in predicting 1-year mortality among elderly patients with femoral fractures. MATERIAL AND METHODS This retrospective cohort study included 309 patients aged ≥65 years who presented to the emergency department of a tertiary university hospital between 2018 and 2023 with low-energy femoral fractures and who underwent surgery. Demographic, clinical, and laboratory data were collected. HALP, PNI, and SII were calculated preoperatively. In-hospital, 30-day, and 1-year mortality were recorded. ROC analysis was used to assess the predictive accuracy of each index. RESULTS One-year mortality was 32.4%, while in-hospital and 30-day mortality were 5.5% and 11%, respectively. Lower albumin and PNI scores were significantly associated with higher mortality at all time points (P<0.001). PNI demonstrated moderate predictive accuracy (AUC=0.659), while HALP had limited but statistically significant predictive value (AUC=0.577, P=0.030). SII did not show statistically significant prognostic value (AUC=0.549, P=0.166). Multivariate analysis showed PNI and HALP are independent predictors of long-term mortality. CONCLUSIONS PNI and HALP are practical, cost-effective tools with prognostic utility in elderly patients with femoral fractures. Early identification of high-risk individuals using these biomarkers may facilitate targeted interventions and improved outcomes. Future multicenter prospective studies are warranted for external validation.
