Association of multidimensional biomarkers of immune, nutritional, inflammatory, and metabolic status with postoperative outcomes in older hip fracture patients: a systematic review and meta-analysis
Abstract
Background: The high mortality and disability rates following hip fractures in the elderly have attracted widespread attention. Underlying inflammatory, immunological, nutritional, and metabolic imbalances are major contributing factors. However, the prognostic value of multidimensional composite biomarkers encompassing these dimensions remains unclear. This systematic review aimed to evaluate the prognostic value of these composite biomarkers for postoperative outcomes in elderly patients with hip fractures.
Methods: A systematic search was conducted in PubMed, Web of Science, Embase, Scopus, the Cochrane Library, ProQuest, and ClinicalTrials.gov, with a cutoff date of 7 January 2026, to identify eligible cohort studies. Data were analyzed using random-effects models for both continuous and cutoff-based categorical variables. Sensitivity analyses were conducted using the modified Knapp-Hartung method with an ad hoc variance correction and a Bayesian hierarchical model. The quality of the evidence was assessed using the GRADE criteria.
Results: A meta-analysis was conducted, incorporating 46 cohort studies involving a total of 28,605 patients. The results showed that baseline immune-inflammatory, nutritional, and metabolic imbalances are associated with the risk of adverse postoperative outcomes. For short-term outcomes, among binary biomarkers, a low prognostic nutritional index (OR = 3.29, 95% CI: 2.22-4.88), a high neutrophil-to-lymphocyte ratio (OR = 5.17, 95% CI:…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 28,605 participants or records.
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