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Objective <p>The current study aimed to systematically and quantitatively evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in predicting mortality among surgical patients with hip fractures through a systematic review and meta-analysis.</p> Design <p>Systematic review and meta-analysis.</p> Methods <p>Four databases—The Cochrane Library, PubMed, Embase, and Web of Science—were comprehensively retrieved to identify studies published from database inception to May 2025 that investigated NLR as a predictor of postoperative survival in hip fracture individuals. Two independent researchers performed study selection, data extraction, and quality assessment, with consistency verified via cross-checking. Statistical analyses were performed using Stata 15.0 for meta-regression and heterogeneity testing, while prognostic performance metrics (sensitivity, area under the curve [AUC], specificity) were synthesized via Meta-Disc 1.4.</p> Results <p>Our meta-analysis incorporated 12 studies, involving 10,015 individuals who underwent surgery for a hip fracture. With cut-off values ranging from 3.2 to 8.4, preoperative NLR demonstrated high prognostic efficacy for mortality prediction, yielding a combined sensitivity of 0.69 (95% CI 0.55–0.83), specificity of 0.84 (0.74–0.93), diagnostic odds ratio (DOR) of 12 (6–26), and an area under the summary receiver operating characteristic curve (sAUC) of 0.84 (0.81–0.87). Subgroup analysis of preoperative NLR thresholds revealed that higher cut-off values (NLR &gt; 5) significantly improved prognostic performance. NLR exhibited superior sensitivity but slightly lower specificity in patients from developing countries, with particular prognostic utility for long-term mortality (≥ 1 year). Postoperative NLR showed moderate prognostic efficacy, with a combined sensitivity of 0.64 (0.57–0.70), specificity of 0.58 (0.55–0.61), DOR of 2 (2–3), and sAUC of 0.62 (0.58–0.66).</p> Conclusion <p>This meta-analysis confirms that the preoperative NLR is a promising albeit preliminary predictor of postoperative mortality in hip fractures.</p>

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Neutrophil-to-lymphocyte ratio for predicting postoperative mortality after hip fracture surgery: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月16日

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  • Cheng Liu,
  • Jingjing Zheng,
  • Yang Bai,
  • Lin Gan,
  • Yanglin Gu

摘要

Objective

The current study aimed to systematically and quantitatively evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in predicting mortality among surgical patients with hip fractures through a systematic review and meta-analysis.

Design

Systematic review and meta-analysis.

Methods

Four databases—The Cochrane Library, PubMed, Embase, and Web of Science—were comprehensively retrieved to identify studies published from database inception to May 2025 that investigated NLR as a predictor of postoperative survival in hip fracture individuals. Two independent researchers performed study selection, data extraction, and quality assessment, with consistency verified via cross-checking. Statistical analyses were performed using Stata 15.0 for meta-regression and heterogeneity testing, while prognostic performance metrics (sensitivity, area under the curve [AUC], specificity) were synthesized via Meta-Disc 1.4.

Results

Our meta-analysis incorporated 12 studies, involving 10,015 individuals who underwent surgery for a hip fracture. With cut-off values ranging from 3.2 to 8.4, preoperative NLR demonstrated high prognostic efficacy for mortality prediction, yielding a combined sensitivity of 0.69 (95% CI 0.55–0.83), specificity of 0.84 (0.74–0.93), diagnostic odds ratio (DOR) of 12 (6–26), and an area under the summary receiver operating characteristic curve (sAUC) of 0.84 (0.81–0.87). Subgroup analysis of preoperative NLR thresholds revealed that higher cut-off values (NLR > 5) significantly improved prognostic performance. NLR exhibited superior sensitivity but slightly lower specificity in patients from developing countries, with particular prognostic utility for long-term mortality (≥ 1 year). Postoperative NLR showed moderate prognostic efficacy, with a combined sensitivity of 0.64 (0.57–0.70), specificity of 0.58 (0.55–0.61), DOR of 2 (2–3), and sAUC of 0.62 (0.58–0.66).

Conclusion

This meta-analysis confirms that the preoperative NLR is a promising albeit preliminary predictor of postoperative mortality in hip fractures.