Key result
An elevated Systemic Immune-Inflammation Index (>752.6×10^9) was independently associated with the occurrence of postoperative delirium in older patients with intertrochanteric fractures (OR 0.311).
Why the study?
The clinical value of the systemic immune-inflammation index (SII) in postoperative delirium had not been investigated in older intertrochanteric fracture patients.
Does an increased Systemic Immune-Inflammation Index predict postoperative delirium in older intertrochanteric fracture patients?
Cohort (n=293)
No
Does an increased Systemic Immune-Inflammation Index predict postoperative delirium in older intertrochanteric fracture patients?
Odds Ratio: 0.311 (95% CI 0.158–0.614)
p-value: p=0.001
An elevated preoperative Systemic Immune-Inflammation Index is an independent predictor of postoperative delirium in older patients undergoing surgery for intertrochanteric fractures.
May aid preoperative delirium risk stratification in older hip fracture patients; hypothesis-generating and requires prospective validation.
Background and Purpose Systemic immune-inflammation index (SII), a novel inflammation index derived from counts of circulating platelets, neutrophils and lymphocytes, has been studied in developing incident acute cancer and ischemic stroke (AIS). However, the clinical value of SII in postoperative delirium patients had not been further investigated. The purpose of our research was to study the incidence and preoperative risk factors for postoperative delirium (POD) and verify whether SII could serve as a potential marker for POD in older intertrochanteric fracture patients. Finally, we create a novel nomogram for predicting POD patients with older intertrochanteric fracture. Methods We enrolled elderly patients with intertrochanteric fracture who underwent proximal femoral nail anti-rotation(PFNA)between February 2021 to April 2023. Uni variate and multivariate logistic analyses were performed to confirm the risk factors and then construct a nomogram model. The calibration curve and clinical decision curve analysis (DCA) were used to assess the model’s fitting performance. The performance of the nomogram was evaluated for discrimination, calibration, and clinical utility. Results 293 patients were eligible for inclusion in the study, 25.6% (75/293) of patients had POD. The POD patients had higher SII levels than the non-POD group. SII is the stronger correlator for POD in older intertrochanteric fracture patients, of which the optimal cut-off value was 752.6×10 9 . Multivariate analysis revealed that the age, diabetes, total albumin,SII > 752.6×10 9 and CRP > 20.25mg/L were independent risk factors for POD patients. Incorporating these 5 factors, the model achieved a concordance index of 0.745 (95% CI, 0.683–0.808) and had a well-fitted calibration curve and good clinical application value. Conclusion The SII was a simple and valuable biomarker for POD, and the new nomogram model based on it can accurately forecast the occurrence of POD. They can be utilized in clinical practice to identify those at high risk of POD in older intertrochanteric fracture patients.
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Yan et al. (2023) conducted a cohort in Intertrochanteric fracture (n=293). Systemic Immune-Inflammation Index (SII) > 752.6×10^9 vs. SII ≤ 752.6×10^9 was evaluated on Incidence of postoperative delirium (POD) within seven days postoperatively (OR 0.311, 95% CI 0.158-0.614, p=0.001). An elevated Systemic Immune-Inflammation Index (>752.6×10^9) was independently associated with the occurrence of postoperative delirium in older patients with intertrochanteric fractures (OR 0.311).
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