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. 2025 Aug;17(8):2350-2361.
doi: 10.1111/os.70107. Epub 2025 Jul 10.

Correlation of Preoperative Inflammation/Immunity Markers With Postoperative Urinary Tract Infections in Elderly Hip Fracture Patients

Xiao-Yang Liu  1 , Si-Qin Guo  2 , Xu-Ming Chen  1 , Wei-Nan Zeng  1 , Zong-Ke Zhou  1
Affiliations

Correlation of Preoperative Inflammation/Immunity Markers With Postoperative Urinary Tract Infections in Elderly Hip Fracture Patients

Xiao-Yang Liu et al. Orthop Surg. 2025 Aug.

Abstract

Objective: Given the rising incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures and their substantial impact on mortality and functional recovery, identifying accessible predictors for early risk stratification is critical to improving perioperative management. This study aimed to investigate the association between preoperative inflammation/immune markers and the occurrence of postoperative UTIs in the vulnerable population.

Methods: This study examined elderly patients who underwent hip surgery for hip fractures at our institution from March 2014 to June 2024. Preoperative inflammation/immune markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were measured. Receiver operating characteristic (ROC) curves were used to identify optimal cutoff values for each marker. To control the potential confounding factors, multivariate logistic regression analysis and propensity score matching analysis were conducted, resulting in adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the strength of the association between each marker and UTIs.

Results: A total of 1238 patients were included in this study, of whom 287 (23.18%) developed postoperative UTIs. Among elderly hip fracture patients, NLR demonstrated the highest predictive value for postoperative UTIs compared to PLR and SII (area under the curve [AUC] = 0.608, 95% CI: 0.571-0.645). High NLR (OR = 1.57, 95% CI: 1.16-2.13), high PLR (OR = 1.59, 95% CI: 1.16-2.19), and high SII (OR = 1.75, 95% CI: 1.29-2.37) were significantly associated with the incidence of postoperative UTIs using the best cutoff values. Additionally, a dose-effect relationship was observed for this association (p for trend < 0.05). These results remained significant even after propensity score matching.

Conclusions: Preoperative inflammatory/immune markers NLR, PLR, and SII exhibited independent associations with the development of postoperative UTIs in elderly hip fracture patients undergoing surgery. Furthermore, a dose-effect relationship was observed for this association.

Keywords: NLR; PLR; SII; elderly; hip fracture; urinary tract infections.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of patients included in the cohort.
FIGURE 2
FIGURE 2
ROC curve analysis was performed to evaluate the predictive value of each inflammation/immunity marker for postoperative urinary tract infections in hip fracture patients. Compared to the established scoring system for hip fracture patients, which includes PLR and SII (B, C), NLR (A, D) demonstrated the highest accuracy in predicting postoperative UTIs. AUC, area under the curve; NLR, neutrophil‐to‐lymphocyte ratio; PLR, platelet‐to‐lymphocyte ratio; ROC, receiver operating characteristic; SII, systemic immune‐inflammation index.
FIGURE 3
FIGURE 3
The relationship between inflammation/immunity markers and postoperative urinary tract infections in elderly patients with hip fractures was examined. The predictive probabilities and observed rates of postoperative UTIs were analyzed based on the baseline levels of NLR (A), PLR (B), and SII (C); adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative UTIs were estimated based on the baseline levels of NLR (A), PLR (B), and SII (C).
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