A Novel Indicator for Predicting Functional Recovery in Elderly Hip Fracture Patients

Weicheng Wu ¹ Zhening Guo ² Peiyao Zhu ¹ Bo Lv ² Yongtao Mao ¹ Chang She ¹ Wei Xu ¹ Jun Gu ¹ Jie Pan ^2* Liubing Li ^1,3*

• ¹ Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
• ² Department of Pharmacy, Second Affiliated Hospital of Soochow University, Suzhou, Liaoning Province, China
• ³ State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, Liaoning Province, China

Background: The inflammatory response following hip fracture significantly influences postoperative functional recovery in patients. However, to date, no inflammatory index has been identified as a reliable and accurate predictor of functional recovery, especially in elderly patients with hip fractures. This study introduces and evaluates a novel inflammatory marker, the lymphocyte ratio-calcium index (LRCa³), for predicting one-year postoperative functional recovery and compares its performance to that of established markers, including the platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), aggregate index of systemic inflammation (AISI), and systemic inflammation response index (SIRI). Methods: A retrospective analysis was conducted on 111 elderly patients (≥65 years) who underwent hip fracture surgery, and their demographic and laboratory data were analyzed. Patients were classified into good or poor recovery groups based on the Harris hip score (HHS) one year postoperatively. LRCa³ was calculated as the lymphocyte ratio multiplied by the cube of the serum calcium level. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the predictive performance of the LRCa³ and other inflammatory indices. A nomogram prediction model was constructed.Results: ROC curve analysis revealed that, compared with the SII (AUC: 0.601), the SIRI (AUC: 0.61), the AISI (AUC: 0.577), and the MLR (AUC: 0.626) had superior predictive performance.Multivariate logistic regression revealed that the LRCa³ was an independent predictor of one-year functional recovery. The incorporation of LRCa³ into a nomogram further enhanced its predictive 3 capacity, providing a more accurate tool for postoperative outcome assessment.LRCa³ is a novel and effective biomarker for predicting postoperative functional recovery in elderly hip fracture patients. Its integration into clinical practice could facilitate individualized patient management and improve long-term outcomes.