Predictive value of preoperative NLR combined with serum UA and PGE2 levels in elderly patients with hip fractures for postoperative delirium

doi:10.3969/j.issn.1673-8640.2025.10.010

Abstract

Abstract:

Objective To investigate the predictive value of preoperative neutrophil-to-lymphocyte ratio（NLR），uric acid（UA）and prostaglandin E2（PGE2） combined determination for postoperative delirium in elderly patients with hip fractures. Methods A total of 120 elderly patients with hip fractures who underwent surgical treatment at Shijiazhuang Third Hospital from April to December 2023 were enrolled. The clinical data were collected，and preoperative NLR and serum UA and PGE2 levels were determined. Within 3 d after surgery，all the patients were scored using the confusion assessment method-severity（CAM-S） delirium scale，and they were classified into delirium group（27 cases） and non-delirium group（93 cases）. Spearman analysis was used to evaluate the correlation between NLR，UA，PGE2 and American Society of Anesthesiologists（ASA） grades. Multivariate Logistic regression analysis was used to evaluate the influencing factors of postoperative delirium in elderly patients with hip fractures. The efficacy of NLR，UA and PGE2 in judging postoperative delirium in elderly patients with hip fractures was evaluated using receiver operating characteristic（ROC） curve. Results The proportion of ASA grade Ⅲ-Ⅳ，NLR and serum UA and PGE2 levels in delirium group were higher than those in non-delirium group（P<0.05）. NLR，UA and PGE2 were positively correlated with ASA grades（r_s values were 0.447，0.424 and 0.487，respectively，P<0.001）. Elevated NLR，UA and PGE2 were all risk factors for postoperative delirium in elderly patients with hip fractures（P<0.05）. The areas under curves for single and combined determinations of NLR，UA and PGE2 in judging postoperative delirium in elderly patients with hip fractures were 0.834，0.823，0.861 and 0.968，respectively. Conclusions Elevated preoperative NLR and serum UA and PGE2 levels are risk factors for postoperative delirium in elderly patients with hip fractures. The combined determination of NLR，UA and PGE2 can improve the predictive efficacy of postoperative delirium in elderly patients with hip fractures.

Key words: Neutrophil-to-lymphocyte ratio, Uric acid, Prostaglandin E2, Hip fracture, Delirium, Elderly

CLC Number:

R446.1

WANG Mengru, ZHOU Lin, XING Xiqian, CUI Qianqian. Predictive value of preoperative NLR combined with serum UA and PGE2 levels in elderly patients with hip fractures for postoperative delirium[J]. Laboratory Medicine, 2025, 40(10): 987-991.

Figures/Tables 5

References 18

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组别	例数	年龄/岁			性别			BMI/ （kg·m^-2）	既往病史
组别	例数	年龄/岁			男/[例（%）]		女/[例（%）]	BMI/ （kg·m^-2）	糖尿病/[例（%）]		高血压/[例（%）]
谵妄组	27	79.35±7.58			18（66.67）		9（33.33）	22.14±2.08	8（29.63）		11（40.74）
非谵妄组	93	76.09±7.66			56（60.22）		37（39.78）	22.05±2.12	17（18.28）		34（36.56）
统计值		1.951			0.368			0.195	1.634		0.156
P值		0.053			0.544			0.846	0.201		0.693
组别	既往病史							骨折类型
组别	骨质疏松症/ [例（%）]		脑卒中/ [例（%）]			冠心病/ [例（%）]		股骨颈骨折/ [例（%）]	股骨转子间骨折/[例（%）]		股骨转子下骨折/[例（%）]
谵妄组	18（66.67）		12（44.44）			4（14.81）		11（40.74）	13（48.15）		3（11.11）
非谵妄组	50（53.76）		24（25.81）			19（20.43）		36（38.71）	42（45.16）		15（16.13）
统计值	1.419		3.461			0.426		0.099
P值	0.234		0.063			0.514		0.952
组别	ASA分级					骨折至手术时间/h	手术方式
组别	Ⅰ~Ⅱ级/ [例（%）]		Ⅲ~Ⅳ级/ [例（%）]			骨折至手术时间/h	髓内固定/ [例（%）]	髓外固定/ [例（%）]	股骨头置换/[例（%）]			全髋关节置换/[例（%）]
谵妄组	8（29.63）		19（70.37）			29.47±8.66	6（22.22）	4（14.81）	9（33.33）			8（29.63）
非谵妄组	56（60.22）		37（39.78）			29.21±8.70	36（38.71）	18（19.35）	25（26.88）			14（15.05）
统计值	7.865					0.137	3.058
P值	0.005					0.891	0.383
组别	麻醉方式						手术时间/min	术中出血量/mL		住院时间/d
组别	局部麻醉/[例（%）]			全身麻醉/[例（%）]			手术时间/min	术中出血量/mL		住院时间/d
谵妄组	8（29.63）			19（70.37）			84.37±10.68	254.28±47.16		12.46±1.57
非谵妄组	40（43.01）			53（56.99）			80.92±10.74	257.54±46.83		11.98±1.62
统计值	1.561						1.471	0.318		1.365
P值	0.211						0.144	0.751		0.175

组别	例数	年龄/岁			性别			BMI/ （kg·m^-2）	既往病史
组别	例数	年龄/岁			男/[例（%）]		女/[例（%）]	BMI/ （kg·m^-2）	糖尿病/[例（%）]		高血压/[例（%）]
谵妄组	27	79.35±7.58			18（66.67）		9（33.33）	22.14±2.08	8（29.63）		11（40.74）
非谵妄组	93	76.09±7.66			56（60.22）		37（39.78）	22.05±2.12	17（18.28）		34（36.56）
统计值		1.951			0.368			0.195	1.634		0.156
P值		0.053			0.544			0.846	0.201		0.693
组别	既往病史							骨折类型
组别	骨质疏松症/ [例（%）]		脑卒中/ [例（%）]			冠心病/ [例（%）]		股骨颈骨折/ [例（%）]	股骨转子间骨折/[例（%）]		股骨转子下骨折/[例（%）]
谵妄组	18（66.67）		12（44.44）			4（14.81）		11（40.74）	13（48.15）		3（11.11）
非谵妄组	50（53.76）		24（25.81）			19（20.43）		36（38.71）	42（45.16）		15（16.13）
统计值	1.419		3.461			0.426		0.099
P值	0.234		0.063			0.514		0.952
组别	ASA分级					骨折至手术时间/h	手术方式
组别	Ⅰ~Ⅱ级/ [例（%）]		Ⅲ~Ⅳ级/ [例（%）]			骨折至手术时间/h	髓内固定/ [例（%）]	髓外固定/ [例（%）]	股骨头置换/[例（%）]			全髋关节置换/[例（%）]
谵妄组	8（29.63）		19（70.37）			29.47±8.66	6（22.22）	4（14.81）	9（33.33）			8（29.63）
非谵妄组	56（60.22）		37（39.78）			29.21±8.70	36（38.71）	18（19.35）	25（26.88）			14（15.05）
统计值	7.865					0.137	3.058
P值	0.005					0.891	0.383
组别	麻醉方式						手术时间/min	术中出血量/mL		住院时间/d
组别	局部麻醉/[例（%）]			全身麻醉/[例（%）]			手术时间/min	术中出血量/mL		住院时间/d
谵妄组	8（29.63）			19（70.37）			84.37±10.68	254.28±47.16		12.46±1.57
非谵妄组	40（43.01）			53（56.99）			80.92±10.74	257.54±46.83		11.98±1.62
统计值	1.561						1.471	0.318		1.365
P值	0.211						0.144	0.751		0.175

组别	例数	NLR	UA/（μmol·L^-1）	PGE2/（pg·mL^-1）
谵妄组	27	2.56±0.83	436.87±61.26	167.23±52.08
非谵妄组	93	1.69±0.54	345.70±58.39	103.61±32.44
t值		6.463	7.064	7.728
P值		<0.001	<0.001	<0.001

组别	例数	NLR	UA/（μmol·L^-1）	PGE2/（pg·mL^-1）
谵妄组	27	2.56±0.83	436.87±61.26	167.23±52.08
非谵妄组	93	1.69±0.54	345.70±58.39	103.61±32.44
t值		6.463	7.064	7.728
P值		<0.001	<0.001	<0.001

项目	β值	标准误	Wald值	P值	OR值（95% CI）
NLR	1.585	0.465	11.624	0.001	4.881（1.962~12.143）
UA	1.321	0.328	16.213	<0.001	3.746（1.970~7.125）
PGE2	1.374	0.407	11.401	0.001	3.952（1.780~8.775）