A composite inflammation-nutrition-coagulation score and 1-year mortality in geriatric proximal femur fractures: a retrospective cohort study.
5 affiliations
- 1Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep, 27090, Turkey. [email protected].
- 2Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep, 27090, Turkey.
- 3Department of Orthopedics and Traumatology, Abdulkadir Yüksel State Hospital, Gaziantep, 27100, Turkey.
- 4Department of Orthopedics and Traumatology, Pamukkale University, Denizli, 20160, Turkey.
- 5Department of Orthopedics and Traumatology, Mersin City Training and Research Hospital, Mersin, 33240, Turkey.
Abstract
Introduction
This 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
This 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
A 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
In 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.
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BibTeX
@article{bozgeyik2026composite,
title = {{A composite inflammation-nutrition-coagulation score and 1-year mortality in geriatric proximal femur fractures: a retrospective cohort study.}},
author = {Bilgin Bozgeyik and Onur Kaya and Cem Önder and Emre Atmaca and Adnan Çakar},
journal = {Archives of orthopaedic and trauma surgery},
year = {2026},
month = oct,
doi = {10.1007/s00402-026-06512-z},
url = {https://europepmc.org/article/MED/42963489},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A composite inflammation-nutrition-coagulation score and 1-year mortality in geriatric proximal femur fractures: a retrospective cohort study.
AU - Bilgin Bozgeyik
AU - Onur Kaya
AU - Cem Önder
AU - Emre Atmaca
AU - Adnan Çakar
PY - 2026
DA - 2026/10/31
JO - Archives of orthopaedic and trauma surgery
DO - 10.1007/s00402-026-06512-z
UR - https://europepmc.org/article/MED/42963489
AB - Introduction This 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 This 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 A 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 In 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.
SN - 0936-8051
SN - 1434-3916
ER -