Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 15;32(24):e1315-e1323.
doi: 10.5435/JAAOS-D-24-00184. Epub 2024 Jun 6.

Complete Blood Count Ratios Predict Adverse Events After Total Joint Arthroplasty

Ian A Jones  1 , Julian Wier, Matthew S Chen, Kevin C Liu, Ryan Palmer, Cory K Mayfield, Nathanael D Heckmann
Affiliations

Complete Blood Count Ratios Predict Adverse Events After Total Joint Arthroplasty

Ian A Jones et al. J Am Acad Orthop Surg. .

Abstract

Introduction: Complete blood count-based ratios (CBRs), including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are biomarkers associated with the proinflammatory surgical stress response. This study sought to determine whether preoperative CBRs are associated with postoperative complications, protracted hospital length of stay (LOS), and mortality after total joint arthroplasty, as well as establish threshold values for these outcomes for use in future investigations.

Methods: The Premier Healthcare Database was retrospectively queried for adult patients who underwent primary elective total hip arthroplasty or total knee arthroplasty (TKA). Approximate cut-point values for CBRs were identified by bootstrap simulation using the Youden index. Multivariable adjusted restricted cubic spline models using the predicted cut-point value as the threshold for odds of outcomes were created to identify a final threshold value associated with increased adjusted odds ratio (aOR) of study outcomes.

Results: A total of 32,868 total joint arthroplasties (THA: 12,807, TKA: 20,061) were identified. All measures predicted odds of aggregate postoperative complications (THA: NLR TV: 4.60 [aOR = 2.35], PLR TV: 163.4 [aOR = 1.32], MLR TV: 0.40 [aOR = 2.02], SII TV: 977.00 [aOR = 1.54]; TKA: NLR TV: 3.7 [aOR = 1.69], MLR TV: 0.41 [aOR = 1.62], PLR TV: 205.10 [aOR = 1.43], SII TV: 1,013.10 [aOR = 1.62]; all P < 0.05). A MLR > 0.40 [aOR = 1.54] P < 0.001) was associated with LOS ≥3 days after total hip arthroplasty while an NLR > 13.1 [aOR = 1.38] and an MLR > 0.41[aOR = 1.29] were associated with LOS ≥3 days after total knee arthroplasty (both P < 0.001). No association between inflammatory markers and inpatient mortality was observed.

Conclusion: Given CBRs' ability to both predict outcomes and identify patients with a proinflammatory phenotype, the findings of this study provide a framework for future investigations aimed at identifying and treating high-risk patients with immune-modulating therapies. Continued work to validate these findings by applying TVs to interventional clinical trials is needed before wide clinical adoption.

PubMed Disclaimer

References

    1. Kane RL, Saleh KJ, Wilt TJ, Bershadsky B: The functional outcomes of total knee arthroplasty. J Bone Joint Surg 2005;87:1719-1724.
    1. Losina E, Walensky RP, Kessler CL, et al. Cost-effectiveness of total knee arthroplasty in the United States: Patient risk and hospital volume. Arch Intern Med 2009;169:1113-1122.
    1. Lan RH, Yu J, Samuel LT, Pappas MA, Brooks PJ, Kamath AF: How are we measuring cost-effectiveness in total joint arthroplasty studies? Systematic review of the literature. The J arthroplasty 2020;35:3364-3374.
    1. Healy WL, Della Valle CJ, Iorio R, et al.: Complications of total knee arthroplasty: Standardized list and definitions of the knee society. Clin Orthop Relat Res 2013;471:215-220.
    1. Hill CL, Hunter DJ, Niu J, Clancy M, Guermazi A: Synovitis: A potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis – results of a 1 year longitudinal arthroscopic study in 422 patients. Ann Rheum Dis 2005;13:1599-1603.