{ "abstract": "Introduction\n\nThis study aimed to evaluate the prognostic value of a composite score integrating the neutrophil-to-lymphocyte ratio (NLR), serum albumin, and D-dimer levels for predicting 1-year mortality in geriatric patients with proximal femur fractures.Materials and methods\n\nThis retrospective cohort study included 300 patients aged ≥ 65 years who were admitted with proximal femur fractures and underwent surgical treatment between November 2023 and March 2026. Demographic, clinical, and laboratory data were collected from hospital records. A composite score based on NLR, albumin, and D-dimer was calculated. An exploratory unweighted 0-3 composite score was constructed from cohort-derived ROC thresholds for NLR, albumin, and D-dimer. Logistic regression, receiver operating characteristic (ROC) curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), Kaplan-Meier survival analysis, Cox regression, calibration analysis, and decision curve analysis (DCA) were performed to evaluate predictive performance.Results\n\nA total of 300 patients were analyzed, of whom 75 (25.0%) died within 1 year. Non-survivors were older and had significantly higher NLR and D-dimer levels and lower albumin levels (all p < 0.001). In mutually exclusive adjusted regression models, higher NLR and D-dimer levels, lower albumin levels, and a higher composite score were associated with 1-year mortality. In the composite-score model, each 1-point increase in score was associated with mortality after adjustment for clinical covariates (adjusted OR: 2.82, 95% CI: 1.95-4.08; p < 0.001). The composite score and its constituent biomarkers were not entered simultaneously into the same multivariable model. The composite score showed an apparent AUC of 0.86 (95% CI: 0.81-0.90), compared with AUCs of 0.74, 0.76, and 0.78 for NLR, albumin, and D-dimer, respectively. Addition of the score to the basic clinical model yielded a category-free NRI of 0.27 (95% CI: 0.14-0.40; p < 0.001) and an IDI of 0.068 (95% CI: 0.035-0.101; p < 0.001), indicating improved apparent risk separation within the derivation cohort. Kaplan-Meier and Cox regression analyses showed a stepwise increase in mortality risk across score groups (HR: 3.12 for high-risk group, p < 0.001). Calibration and decision-curve analyses suggested favorable apparent model performance and potential net benefit within the present study cohort.Conclusions\n\nIn this retrospective single-center cohort, the composite score integrating NLR, albumin, and D-dimer was associated with 1-year mortality and showed promising apparent discriminatory performance. The score should be considered an exploratory prognostic tool that may complement comprehensive clinical assessment and support future risk-stratification research. Prospective multicenter studies with external validation and evaluation of clinical impact are required before its use in routine practice can be considered.", "abstract_shown": true, "affiliations": [ "Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep, 27090, Turkey. bilginbozgeyik@hotmail.com.", "Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep, 27090, Turkey.", "Department of Orthopedics and Traumatology, Abdulkadir Yüksel State Hospital, Gaziantep, 27100, Turkey.", "Department of Orthopedics and Traumatology, Pamukkale University, Denizli, 20160, Turkey.", "Department of Orthopedics and Traumatology, Mersin City Training and Research Hospital, Mersin, 33240, Turkey." ], "article_type": "research article", "arxiv": null, "author_total": 5, "authors": [ { "affs": [ 0 ], "name": "Bilgin Bozgeyik", "orcid": "0000-0001-9459-6535" }, { "affs": [ 1 ], "name": "Onur Kaya", "orcid": "0000-0002-7164-3156" }, { "affs": [ 2 ], "name": "Cem Önder", "orcid": "0000-0002-8289-8867" }, { "affs": [ 3 ], "name": "Emre Atmaca", "orcid": "0000-0001-9344-4265" }, { "affs": [ 4 ], "name": "Adnan Çakar" } ], "bibtex": "https://research.draconitic.com/paper/91ayr55zpwyg3.bib", "cited_by": 0, "doi": "10.1007/s00402-026-06512-z", "fulltext_url": "https://europepmc.org/articles/PMC13722621", "id": "91ayr55zpwyg3", "issns": [ "0936-8051", "1434-3916" ], "landing_url": "https://europepmc.org/article/MED/42963489", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research" ], [ "openalex", "2746|Hip and Femur Fractures" ] ], "openalex": "W7225000519", "pdf_url": "https://europepmc.org/articles/PMC13722621?pdf=render", "pmcid": "PMC13722621", "pmid": "42963489", "published": "2026-10-31", "publisher": null, "ris": "https://research.draconitic.com/paper/91ayr55zpwyg3.ris", "sources": [ { "first_seen": "2026-11-02T03:21:21Z", "native_id": "MED:42963489", "source": "europepmc", "url": "https://europepmc.org/article/MED/42963489" }, { "first_seen": "2026-11-04T12:21:24Z", "native_id": "PMC13722621", "source": "pmc", "url": "https://doi.org/10.1007/s00402-026-06512-z" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2746|Hip and Femur Fractures", "subfield": "surgery" } ], "title": "A composite inflammation-nutrition-coagulation score and 1-year mortality in geriatric proximal femur fractures: a retrospective cohort study.", "title_text": "A composite inflammation-nutrition-coagulation score and 1-year mortality in geriatric proximal femur fractures: a retrospective cohort study.", "type": "peer-reviewed", "updated_at": "2026-11-04T12:21:24Z", "url": "https://research.draconitic.com/paper/91ayr55zpwyg3", "venue": "Archives of orthopaedic and trauma surgery", "versions": [] }