Incremental Predictive Value of Preoperative Systemic Immune-Inflammation Index and Prognostic Nutritional Index for Postoperative Delirium in Older Patients with Intertrochanteric Fractures.
- 1Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
- 2Department of Orthopedics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
Abstract
This study evaluated the associations of the preoperative systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) with postoperative delirium (POD) and assessed whether adding these biomarkers to baseline clinical factors improved discrimination in older patients undergoing proximal femoral nail antirotation (PFNA) for intertrochanteric fractures. This retrospective cohort study included 346 patients aged ≥60 years (mean age, 79.30 ± 8.16 years), comprising 233 women (67.3%) and 113 men (32.7%), who underwent PFNA for intertrochanteric fractures. Multivariable logistic regression was used to evaluate the associations of SII and PNI with POD. A baseline clinical model incorporating age, smoking, alcohol consumption, chronic obstructive pulmonary disease, and previous stroke was compared with models incorporating SII, PNI, or both biomarkers. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), and AUCs were compared using the DeLong test. An exploratory nomogram was developed from the combined model. Postoperative delirium (POD) occurred in 78 patients (22.54%). In the primary linear model, each 100-unit increase in systemic immune-inflammation index (SII) was associated with higher odds of POD (adjusted odds ratio [OR], 1.054; 95% confidence interval [CI], 1.011-1.100; P = 0.014), whereas each one-unit increase in prognostic nutritional index (PNI)was associated with lower odds of POD (adjusted OR, 0.929; 95% CI, 0.869-0.994; P = 0.033). The baseline model yielded an AUC of 0.733 (95% CI, 0.666-0.799). Adding SII increased the AUC to 0.776 (95% CI, 0.716-0.836; ΔAUC, 0.043; DeLong P = 0.003), whereas adding PNI increased the AUC to 0.763 (95% CI, 0.704-0.822; ΔAUC, 0.030; DeLong P = 0.016). The combined model yielded an AUC of 0.788 (95% CI, 0.732-0.843; ΔAUC, 0.055; DeLong P = 0.001). Higher SII and lower PNI were associated with POD in older patients undergoing PFNA for intertrochanteric fractures. Although adding these biomarkers produced statistically significant improvements in discrimination, the absolute improvements were modest, and the combined model retained only moderate discriminative performance. The model should therefore be considered exploratory and requires external validation before clinical implementation.
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BibTeX
@article{yan2026incremental,
title = {{Incremental Predictive Value of Preoperative Systemic Immune-Inflammation Index and Prognostic Nutritional Index for Postoperative Delirium in Older Patients with Intertrochanteric Fractures.}},
author = {Xiaoxiao Yan and Tingting Zhang and Mian Lin},
journal = {Clinical interventions in aging},
year = {2026},
month = oct,
doi = {10.2147/cia.s635433},
url = {https://europepmc.org/article/MED/42953749},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Incremental Predictive Value of Preoperative Systemic Immune-Inflammation Index and Prognostic Nutritional Index for Postoperative Delirium in Older Patients with Intertrochanteric Fractures.
AU - Xiaoxiao Yan
AU - Tingting Zhang
AU - Mian Lin
PY - 2026
DA - 2026/10/24
JO - Clinical interventions in aging
DO - 10.2147/cia.s635433
UR - https://europepmc.org/article/MED/42953749
AB - This study evaluated the associations of the preoperative systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) with postoperative delirium (POD) and assessed whether adding these biomarkers to baseline clinical factors improved discrimination in older patients undergoing proximal femoral nail antirotation (PFNA) for intertrochanteric fractures. This retrospective cohort study included 346 patients aged ≥60 years (mean age, 79.30 ± 8.16 years), comprising 233 women (67.3%) and 113 men (32.7%), who underwent PFNA for intertrochanteric fractures. Multivariable logistic regression was used to evaluate the associations of SII and PNI with POD. A baseline clinical model incorporating age, smoking, alcohol consumption, chronic obstructive pulmonary disease, and previous stroke was compared with models incorporating SII, PNI, or both biomarkers. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), and AUCs were compared using the DeLong test. An exploratory nomogram was developed from the combined model. Postoperative delirium (POD) occurred in 78 patients (22.54%). In the primary linear model, each 100-unit increase in systemic immune-inflammation index (SII) was associated with higher odds of POD (adjusted odds ratio [OR], 1.054; 95% confidence interval [CI], 1.011-1.100; P = 0.014), whereas each one-unit increase in prognostic nutritional index (PNI)was associated with lower odds of POD (adjusted OR, 0.929; 95% CI, 0.869-0.994; P = 0.033). The baseline model yielded an AUC of 0.733 (95% CI, 0.666-0.799). Adding SII increased the AUC to 0.776 (95% CI, 0.716-0.836; ΔAUC, 0.043; DeLong P = 0.003), whereas adding PNI increased the AUC to 0.763 (95% CI, 0.704-0.822; ΔAUC, 0.030; DeLong P = 0.016). The combined model yielded an AUC of 0.788 (95% CI, 0.732-0.843; ΔAUC, 0.055; DeLong P = 0.001). Higher SII and lower PNI were associated with POD in older patients undergoing PFNA for intertrochanteric fractures. Although adding these biomarkers produced statistically significant improvements in discrimination, the absolute improvements were modest, and the combined model retained only moderate discriminative performance. The model should therefore be considered exploratory and requires external validation before clinical implementation.
SN - 1176-9092
SN - 1178-1998
ER -