Correlation between Neutrophil-to-lymphocyte ratio and Euthyroid Sick Syndrome in elderly patients with proximal femur fractures

OBJECTIVE: Proximal femur fractures are among the most common type of trauma in elderly patients, and Euthyroid sick syndrome has already been related to fractures and trauma. The evidence of a consistent inflammatory state occurring during hip fracture, made us consider as a potential marker also the neutrophil-to-lymphocyte ratio (NLR), which is already in use to measure the prognosis and guide the therapeutic management in various conditions. PATIENTS AND METHODS: A retrospective observational analysis on patients affected by proximal femur fractures was conducted. Patients were divided between affected and non-affected by Euthyroid Sick Syndrome (ESS). Standard follow up was conducted at 1, 3, 6 and 12 months. RESULTS: 79 patients were enrolled in this study. There were 19 males and 60 females, the mean age was 83.8 +/- 6.5 y.o., and 44 patients were affected by ESS. Affected patients showed higher NLR values (10.2 +/- 9.4 vs. 6.9 +/- 3.9; p= 0.001) and higher decrease in fT3 values in the 1st post-operative day (1.8 +/- 0.4 vs. 2.2 +/- 0.3; p= 0.001), higher values of PTH (97.9 +/- 46.2 vs. 70.1 +/- 36.2; p=0.004) and lower levels of Vitamin D (18.8 +/- 7.8 vs. 23.5 +/- 12.9; p= 0.04). As regards complications, we found them in 27% of patients in group A, while only in 8% in Group B, with a statistically significant difference (p= 0.03). CONCLUSIONS: ESS and NLR are promising prognostic markers in PFF in the elderly patients. If used together, they could help in the pre- and post-operative management of the patients.