Osteoporotik kalça kırığı nedeni ile opere olan hastalarda nötrofil / lenfosit ve platelet / lenfosit oranlarının mortaliteye etkisi
Yükleniyor...
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Geriatrik osteoporotik kalça kırıkları mortalitesi ve morbiditesi yüksek yaralanmalardır. Bu çalışmada amaç osteoporotik kalça kırığı tedavisinde uygulananan artroplasti (total kalça protezi ve parsiyel kalça protezi), intramedüller çivileme ve kayan kalça vidası yöntemlerinden herhangi biri ile kırık tespiti yapılmış hastaların, rutin hemogram testlerindeki hemoglobin (Hb), nötrofil (N), platelet (P) ve lenfosit (L) değerleri ve nötrofil/lenfosit oranı (NLO), platelet/lenfosit oranı (PLO) değerlerinin mortalite üzerine etkisini incelemektir. Aynı zamanda demografik özellikler, komorbid hastalıklar, anestezi tipi ve ASA skoru, kırık nitelikleri, vücut kitle indeksi (VKİ) ve yatış-cerrahi süresi (YCS) ile mortalite arasındaki ilişkisinin ortaya konması amaçlanmıştır. Materyal ve metod: Bu çalışma tek merkezli, retrospektif çalışmadır. Çalışmaya 60-120 yaş arası geriatrik osteoporotik kalça kırığı (femur boyun kırığı, intertrokanterik ve subtrokanterik kırık) olan ve kliniğimizde kalça kırığı nedeniyle artroplasti (total kalça protezi ve parsiyel kalça protezi), intramedüller çivileme veya kayan kalça vidası ile kırık tespiti uygulanmış olan 226 hasta alınmıştır. Hastalarımız cerrahi sonrası 30 gün içinde ölenler (Grup 1), 1-12 ay içinde ölenler (Grup 2) ve 12 aydan uzun sağ kalanlar (Grup 3) olarak 3 gruba ayrıldı. Çalışmaya dahil edilen hastalara ait demografik özellikler (yaş, cinsiyet, VKİ) ile komorbid hastalık sayısı, uygulanan anestezi tipi, ASA skoru, yatıştan cerrahiye kadar geçen süre, kırık tipi, uygulanan cerrahi tespit yöntemi, ameliyat öncesi, ameliyat sonrası 1. ve 5. günlerdeki hemoglobin, nötrofil, platelet, lenfosit değerleri ile nötrofil/lenfosit ve platelet/lenfosit oranları hesaplanmış ve bu değerler ile 30 günlük ve 1 yıllık mortalite arasındaki ilişki Pearson ki-kare, Kruskal-Wallis ve Mann-Whitney U testleri ile değerlendirilmiştir. Bulgular: Hastalarımızın 13'ü ilk 30 günde 36'sı da 1-12 ay arasında ölmüştür. Yaş ile hem 30 günlük hemde 1 yıllık mortalite ilişkisinin anlamlı olduğu (p=0.002), her 1 yaş artışının 30 günlük mortalite riskini 1.11 kat ve 1 yıllık mortalite riskini ise 1.06 kat arttırdığı gösterilmiştir (p=0.013, p=0.01, sırasıyla). Ameliyat öncesi, ameliyat sonrası 1. ve 5. günlerdeki lenfosit değerleri ile ameliyat sonrası 5. gün nötrofil değerlerinin mortaliteyle istatistiksel ilişkili olduğu saptanmıştır (lenfosit için p<0.001, p=0.007, p=0.002, nötrofil için p=0.001 sırasıyla). Benzer şekilde her 3 NLO değeri ile mortalite arasında istatistiksel anlamlı sonuç olduğu görülmüştür (p<0.001, p=0.001, p<0.001, sırasıyla). Ameliyat öncesi NLO değerindeki her 1 birimlik artışın 30 günlük mortalite riskini 1.26 kat, 1 yıllık mortalite riskini ise 1.14 kat arttırdığı gösterilmiştir (her iki p<0.001). Ameliyat sonrası 5. gündeki NLO değerindeki her 1 birimlik artışın hem 30 günlük hem de 1 yıllık mortalite riskini 1.16 kat arttırdığı saptanmıstır (p=0.001, p<0.001, sırasıyla). ROC analizinde ameliyat öncesi, ameliyat sonrası 1. ve 5. gün NLO değerleri ile 30 günlük ve 1 yıllık sağkalım arasında istatistiksel anlamlı ilişki bulunmuştur (ameliyat öncesi NLO p=0.004, p<0.001;ameliyat sonrası 1. gün NLO p=0.033, p<0.001; ameliyat sonrası 5. gün NLO p=0.018, p<0.001, sırasıyla). PLO açısından ise ameliyat sonrası 1. gün hariç diğer 2 değer ile mortalite arasında anlamlılık olduğu saptanmıştır (p=0.003, p=0.001, sırasıyla). ROC analizinde ameliyat öncesi ve ameliyat sonrası 5. gün PLO değerleri ile 30 günlük ve 1 yıllık sağkalım arasında istatistiksel olarak anlamlı ilişki bulunmuştur (ameliyat öncesi PLO, p=0.011, p=0.002; ameliyat sonrası 5. gün p=0.018, p<0.001, sırasıyla). Cinsiyet, komorbid hastalık sayısı, kırık tipi, yapılan ameliyat tipi, ASA skoru, uygulanan anestezi tipi, yatış cerrahi süresi, vücut kitle indeksi, kan parametrelerinden hemoglobin ve platelet için ameliyat öncesi, ameliyat sonrası 1. ve 5. gün değerleri ve nötrofil için ameliyat öncesi ve ameliyat sonrası 1. gün değerleri ile mortalite arasındaki ilişkinin istatistiksel olarak anlamlı olmadığı bulundu. Sonuç: NLO ve PLO değerleri ek herhangi bir laboratuar testine ihtiyaç duymayan nötrofil, trombosit ve lenfosit sayıları üzerinden kolayca hesaplanan parametrelerdir. NLO ve PLO değerlerinin ameliyat sonrası dönemde yüksek seyretmesinin devam eden katabolik sürecin göstergesi niteliğinde olduğunu ve buna bağlı olarak mortalite riskinde artışa sebep olduğunu düşünmekteyiz. Çalışmamızın özgünlüğü NLO ve PLO değerlerinin ameliyat öncesi ve sonrası dönemleri kapsayacak şekilde değerlendirilmiş olmasıdır. Anahtar kelimeler: Geriatrik kalça kırığı, Nötrofil/Lenfosit Oranı, Platelet/Lenfosit Oranı, Mortalite.
Objectives: Geriatric osteoporotic hip fractures are injuries with high mortality and morbidity. The aim of this study was to determine the effect of hemoglobin (Hb), neutrophil (N), platelet (P), lymphocyte (L) values and neutrophil/lymphocyte (NLO), platelet/lymphocyte ratios (PLO) on mortality of the patients with osteoporotic hip fractures, treated arthroplasty (total hip replacement and partial hip replacement), intramedullary nailing and dynamic hip screw fixation. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) values have been calculated to exemine their effects on mortality. We also aimed to reveal the relationship between demographic characteristics, comorbid diseases, anesthesia type and ASA score, fracture characteristics, body mass index (BMI) and hospitalization-surgery duration and mortality fort his patients. Materials and methods: This study is a single center, retrospective study. The study included 226 patients aged 60-120 years with geriatric osteoporotic hip fractures (femoral neck fracture, intertrochanteric and subtrochanteric fracture) and who underwent arthroplasty (total hip replacement and partial hip replacement), intramedullary nailing or dynamic hip screw for hip fracture in our clinic. Our patients were divided into 3 groups as those who died within 30 days after surgery (Group 1), those who died within 1-12 months (Group 2), and those who survived more than 12 months (Group 3). The demographic characteristics (age, gender, BMI) of the patients included in the study, number of comorbid diseases, type of anesthesia applied, ASA score, time of hospitalization until surgery, type of fracture, method of surgical fixation, preoperative, and postoperative first and fifth days hemoglobin, neutrophil, platelet, lymphocyte values and neutrophil/lymphocyte and platelet/lymphocyte ratios were calculated and the relationship between these values and 30-day and 1-year mortality was evaluated by Pearson chi-square, Kruskal-Wallis and Mann-Whitney U tests. Results: 13 of our patients died in the first 30 days and 36 of them died between 1-12 months. It has been shown that there is a significant relationship between age and both 30-day and 1-year mortality (p=0.002), with every 1-year increase in age increased the risk of mortality 1.11 times and 1-year mortality 1.06 times increased (p=0.013, p=0.01, respectively). It was determined that the lymphocyte values on the preoperative, postoperative first and fifth days and the postoperative fifth day neutrophil values were statistically associated with mortality (for lymphocytes, p<0.001, p=0.007, p=0.002, for neutrophils p=0.001 respectively). Similarly, it was observed that there was a statistically significant relation between all 3 NLR values and mortality (p<0.001, p=0.001, <0.001, respectively). It has been shown that each 1-unit increase in the preoperative NLR value increases the 30-day mortality risk 1.26 times and the 1-year mortality risk 1.14 times (both p <0.001). It was found that each 1-unit increase in NLR on the fifth day after surgery results in an increase both 30-day and 1-year mortality risk 1.16 times (p = 0.001, p <0.001, respectively). In the ROC analysis, a statistically significant relationship was found between preoperative, postoperative first and fifth days NLR values with 30-day and 1-year survival (preoperative NLR p=0.004, p<0.001; postoperative first day NLR p=0.033, p<0.001; postoperative fifth day NLR p=0.018, p<0.001, respectively). In terms of PLR, it was found that there is a significant difference between the other 2 values except the 1st day after surgery with mortality (p=0.003, p=0.001, respectively). In the ROC analysis, a statistically significant relationship was found between preoperative and postoperative 5th day PLO values with 30-day and 1-year survival (preoperative PLR, p=0.011, p=0.002; postoperative fifth day, p=0.018, p<0.001, respectively). Gender, number of comorbid diseases, fracture type, type of surgery performed, ASA score, type of anesthesia applied, hospitalization-surgery duration, body mass index, preoperative, postoperative first and fifth days values for hemoglobin and platelet parameters, preoperative and postoperative first day neutrophil parameters were not associated with mortality statistically. Conclusion: NLR and PLO values are parameters that are easily calculated from the neutrophil, thrombocyte and lymphocyte counts, which do not require any additional laboratory tests. We think that the high NLR and PLO values in the postoperative period are indicative of the ongoing catabolic process and therefore increase the mortality risk. The specificity of our study is that the NLR and PLO values were evaluated to cover whole pre- and postoperative periods. Keywords: Geriatric hip fracture, Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, Mortality.
Objectives: Geriatric osteoporotic hip fractures are injuries with high mortality and morbidity. The aim of this study was to determine the effect of hemoglobin (Hb), neutrophil (N), platelet (P), lymphocyte (L) values and neutrophil/lymphocyte (NLO), platelet/lymphocyte ratios (PLO) on mortality of the patients with osteoporotic hip fractures, treated arthroplasty (total hip replacement and partial hip replacement), intramedullary nailing and dynamic hip screw fixation. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) values have been calculated to exemine their effects on mortality. We also aimed to reveal the relationship between demographic characteristics, comorbid diseases, anesthesia type and ASA score, fracture characteristics, body mass index (BMI) and hospitalization-surgery duration and mortality fort his patients. Materials and methods: This study is a single center, retrospective study. The study included 226 patients aged 60-120 years with geriatric osteoporotic hip fractures (femoral neck fracture, intertrochanteric and subtrochanteric fracture) and who underwent arthroplasty (total hip replacement and partial hip replacement), intramedullary nailing or dynamic hip screw for hip fracture in our clinic. Our patients were divided into 3 groups as those who died within 30 days after surgery (Group 1), those who died within 1-12 months (Group 2), and those who survived more than 12 months (Group 3). The demographic characteristics (age, gender, BMI) of the patients included in the study, number of comorbid diseases, type of anesthesia applied, ASA score, time of hospitalization until surgery, type of fracture, method of surgical fixation, preoperative, and postoperative first and fifth days hemoglobin, neutrophil, platelet, lymphocyte values and neutrophil/lymphocyte and platelet/lymphocyte ratios were calculated and the relationship between these values and 30-day and 1-year mortality was evaluated by Pearson chi-square, Kruskal-Wallis and Mann-Whitney U tests. Results: 13 of our patients died in the first 30 days and 36 of them died between 1-12 months. It has been shown that there is a significant relationship between age and both 30-day and 1-year mortality (p=0.002), with every 1-year increase in age increased the risk of mortality 1.11 times and 1-year mortality 1.06 times increased (p=0.013, p=0.01, respectively). It was determined that the lymphocyte values on the preoperative, postoperative first and fifth days and the postoperative fifth day neutrophil values were statistically associated with mortality (for lymphocytes, p<0.001, p=0.007, p=0.002, for neutrophils p=0.001 respectively). Similarly, it was observed that there was a statistically significant relation between all 3 NLR values and mortality (p<0.001, p=0.001, <0.001, respectively). It has been shown that each 1-unit increase in the preoperative NLR value increases the 30-day mortality risk 1.26 times and the 1-year mortality risk 1.14 times (both p <0.001). It was found that each 1-unit increase in NLR on the fifth day after surgery results in an increase both 30-day and 1-year mortality risk 1.16 times (p = 0.001, p <0.001, respectively). In the ROC analysis, a statistically significant relationship was found between preoperative, postoperative first and fifth days NLR values with 30-day and 1-year survival (preoperative NLR p=0.004, p<0.001; postoperative first day NLR p=0.033, p<0.001; postoperative fifth day NLR p=0.018, p<0.001, respectively). In terms of PLR, it was found that there is a significant difference between the other 2 values except the 1st day after surgery with mortality (p=0.003, p=0.001, respectively). In the ROC analysis, a statistically significant relationship was found between preoperative and postoperative 5th day PLO values with 30-day and 1-year survival (preoperative PLR, p=0.011, p=0.002; postoperative fifth day, p=0.018, p<0.001, respectively). Gender, number of comorbid diseases, fracture type, type of surgery performed, ASA score, type of anesthesia applied, hospitalization-surgery duration, body mass index, preoperative, postoperative first and fifth days values for hemoglobin and platelet parameters, preoperative and postoperative first day neutrophil parameters were not associated with mortality statistically. Conclusion: NLR and PLO values are parameters that are easily calculated from the neutrophil, thrombocyte and lymphocyte counts, which do not require any additional laboratory tests. We think that the high NLR and PLO values in the postoperative period are indicative of the ongoing catabolic process and therefore increase the mortality risk. The specificity of our study is that the NLR and PLO values were evaluated to cover whole pre- and postoperative periods. Keywords: Geriatric hip fracture, Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, Mortality.
Açıklama
Anahtar Kelimeler
Ortopedi ve Travmatoloji = Orthopedics and Traumatology
