Title : Perioperative low Eosinophil Count (EC) as a predictor of poor outcomes in patients with a Hip Fracture(HF)
Abstract:
Background: There is growing interest in the role of eosinophils in pathogenesis and for prognostication outcomes in various diseases. Our aim was to investigate the prognostic significance of eosinophil count (EC) in patients with an osteoporotic hip fracture (HF).
Methods: We analysed in 1273 consecutive patients with HF (mean age 82.9 ± 8.7[SD] years, 73.5% women) prospectively recorded data on sociodemographic, laboratory and comorbid characteristics, complications, and in-hospital outcomes.
Results: Preoperatively, patients with the lowest EC quartile (≤0.01×109/L) compared to those with the highest EC quartile (0.11×109/L) had a 3.6-fold higher risk of hospital death (OR 3.6, 95 % CI 1.43-9.05, p=0.007); this characteristic identified 33% of all fatal outcomes (21 of 61 patients). Postoperatively, lowest EC quartile was associated with a 5.5- fold higher risk of death (OR 5.5, 95% CI 1.89- 16.04 , p= 0.001), a 1.5- fold higher risk of developing postoperative myocardial injury (OR 1.15, 95%CI 1.01-2.09, p=0.013) and a 1.8-fold increased risk of prolonged length of hospital stay ( ≥ 20 days, OR 1.8, 95% CI 1.25-2.65 , p=0.002); low EC identified these outcomes in 47.0% (24/51), 31.0 % (162/523 ), and 34.7 % (96/277) of patients, respectively.
Low EC (pre- and postoperatively) correlated significantly with 7 routine predictive indicators of adverse HF outcomes, including lymphocyte count <1.2 x109/L, neutrophil count >7.5 x 10 9 /L , neutrophil /lymphocyte ratio >7.5 , platelet /lymphocyte ratio>280, Lymphocyte /monocyte ratio<1.1, Neutrophil /albumin ratio x10>2.4 and Neutrophil /monocyte ratio>12.14 (all with p<0.001);it appears that these prognostic markers are superfluous in subjects with low EC.
Conclusion: In HF patients, low perioperative EC can serve as an independent predictor of poor outcomes including myocardial injury, length of hospital stay and in-hospital death.
