The Relationship Between Systemic Immuno-Inflammation Index/Albumin Ratio and C- Reactive Protein/Albumin Ratio and In-Hospital Mortality in Geriatric Hip Fracture Patients: A Retrospective Cohort Study

The Relationship Between Systemic Immuno-Inflammation Index/Albumin Ratio and C- Reactive Protein/Albumin Ratio and In-Hospital Mortality in Geriatric Hip Fracture Patients: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship Between Systemic Immuno-Inflammation Index/Albumin Ratio and C- Reactive Protein/Albumin Ratio and In-Hospital Mortality in Geriatric Hip Fracture Patients: A Retrospective Cohort Study Kadir ARSLAN, Hale Cetin Arslan, Ayca Sultan Sahin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9227029/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Geriatric hip fractures are one of the leading causes of morbidity and mortality. The systemic inflammatory response following hip fracture and the accompanying malnutrition are influential in prognosis. The aim of this study is to investigate the relationship between the systemic immune inflammation index/albumin (SII/Alb) ratio and the C-reactive protein/albumin (CRP/Alb) ratio at admission and in-hospital mortality in patients who underwent surgery for geriatric hip fracture and were followed up in the intensive care unit (ICU) in the postoperative period. Methods This retrospective observational study, conducted at a tertiary hospital between January 2023 and January 2025, included patients who underwent surgery for hip fracture and were followed in the ICU postoperatively. Demographic data, comorbidities, ICU scores, and routine laboratory results at admission were recorded. SII/Alb and CRP/Alb ratios were calculated. The primary endpoint was defined as in-hospital mortality. Multivariate logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) analyses were used to assess prognostic performance. Results A total of 233 patients were included in the study. The in-hospital mortality rate was 7.7%. Age and male sex were significantly higher in the mortality group (p = 0.042 and p = 0.024, respectively). Median SII (4464 vs. 2253, p = 0.001), SII/Alb (1767 vs. 745, p < 0.001), and CRP/Alb (21.7 vs. 6.2, p = 0.001) values were significantly higher in the mortality group. In multivariate regression analysis, SII/Alb (OR = 1.003; p = 0.019), CRP/Alb (OR = 1.077; p = 0.010), and the acute physiology and chronic health evaluation-II (APACHE-II) score (OR = 1.225; p < 0.001) were identified as independent predictors of in-hospital mortality. ROC analysis showed that the area under the curve (AUC) was 0.873 for APACHE-II, 0.794 for SII/Alb, 0.736 for SII, and 0.727 for the CRP/Alb ratio. Conclusions In critically ill geriatric patients with hip fractures, the SII/Alb and CRP/Alb ratios at admission are effective and easily accessible biomarkers for predicting in-hospital mortality. These biomarkers may be useful for early risk stratification and clinical decision-making. Hip Fractures systemic immune-inflammation index critically ill elderly patients C-reactive protein albumin prognostic value in-hospital mortality Figures Figure 1 Introduction Geriatric hip fractures are among the leading causes of trauma-related morbidity and mortality in older adults. Despite advances in surgical techniques and perioperative care, early complications and the risk of death remain major challenges in clinical practice. Although a decline in mortality rates has been observed with the development of modern medicine, the 1-year mortality rate after hip fracture is still reported to be 17–25% [1–3]. In critically ill geriatric patients, a multisystem clinical condition emerges in which the fracture-triggered systemic stress response, inflammation, immobilization, and comorbidity burden converge. Therefore, early risk stratification using rapid and low-cost biomarkers capable of predicting short-term outcomes such as in-hospital mortality is of critical importance. This approach is also beneficial for anticipating the need for intensive care, perioperative optimization, and healthcare resource planning [4]. The systemic inflammatory response following hip fracture and the accompanying tendency toward malnutrition and sarcopenia are among the main determinants of prognosis. The C-reactive protein/albumin ratio (CRP/Alb), which can be derived from routine blood tests, has gained increasing attention because it combines an inflammatory marker (CRP) with a nutritional/reserve indicator (albumin) in a single measurement. In the geriatric population, the CRP/Alb ratio has been reported to have both short- and long-term prognostic value [5,6]. In geriatric patients undergoing hemiarthroplasty for hip fracture, the CRP/Alb ratio has been shown to be an independent predictor of 1-year mortality [6]. On the other hand, the systemic immune-inflammation index (SII; platelet × neutrophil / lymphocyte), calculated from complete blood count parameters, is a useful index reflecting both inflammatory activity and suppression of the immune response. SII has been suggested to have prognostic value in critically injured trauma patients and in patients with hip fractures [7,8]. In critically ill geriatric patients with hip fractures, nutritional status is also known to have prognostic value [9]. Based on this, a single inflammatory marker may be insufficient to determine prognosis in elderly patients with hip fractures; therefore, it is considered that calculating SII in relation to albumin (SII/Alb), which integrates both inflammation and nutritional status, may provide a more comprehensive assessment [10]. Although only a limited number of studies have investigated the prognostic value of the SII/Alb ratio, there is a lack of sufficient evidence regarding its prognostic significance specifically in geriatric patients with hip fractures. Given the prominent role of both inflammation and the high prevalence of malnutrition in this population, we hypothesized that the SII/Alb ratio could influence postoperative outcomes in geriatric patients with hip fractures. Accordingly, the aim of this retrospective observational study was to evaluate the prognostic value of the admission SII/Alb and CRP/Alb ratios for in-hospital mortality in geriatric patients who underwent surgery for hip fracture and were subsequently followed in the intensive care unit (ICU) during the postoperative period. Methods Patients and Study Design This retrospective observational study was initiated after obtaining approval from the institutional ethics committee (date: 25.06.2025, KAEK/2025.06.162). The study was conducted in accordance with the principles of the Declaration of Helsinki. Patients who underwent surgery for hip fracture and were followed in the ICU during the postoperative period between January 2023 and January 2025 at the University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital were included in the study. Patient data were obtained from the hospital information system and medical records. The inclusion criteria were: (1) age ≥65 years; (2) undergoing surgery for hip fracture and being monitored in the ICU during the postoperative period. The exclusion criteria were: (1) trauma at a site other than the hip fracture; (2) chronic kidney disease requiring dialysis; (3) severe liver disease; (4) malignancy; (5) use of medications that may cause bone marrow suppression; (6) cardiovascular depression or cardiac arrest during the perioperative period; (7) a history of viral or bacterial infection within the previous two weeks; and (8) missing data. Data Collection Demographic data, American Society of Anesthesiologist (ASA) physical status, comorbidities, admission Glasgow Coma Scale (GCS) score, acute physiology and chronic health evaluation-II (APACHE-II) score, routine laboratory parameters, and in-hospital mortality were recorded for geriatric patients who underwent hemiarthroplasty or proximal femoral nailing for hip fracture and were followed in the ICU during the postoperative period. Patients were classified into survivor and mortality groups, and the data were compared between these groups. Systemic immune-inflammatory index / Albumin ratio The SII/Alb ratio combines the SII, which reflects systemic inflammatory burden, with serum albumin levels, which are inversely related to inflammation, thereby providing a more comprehensive prognostic biomarker than indicators of inflammation or nutritional status alone. In traumatic orthopedic conditions such as geriatric hip fractures, the interaction between the systemic inflammatory response and malnutrition plays a critical role in clinical outcomes, further enhancing the prognostic relevance of the SII/albumin ratio [11]. SII was calculated using complete blood count parameters obtained at ICU admission in the postoperative period as follows: SII = (platelet count × neutrophil count) / lymphocyte count. Subsequently, the SII/Alb ratio was calculated by dividing the SII value by the serum albumin level measured at the same time point: SII/Alb = SII / Alb (g/dL). By integrating the systemic inflammatory and immune response burden reflected by SII with the nutritional/reserve status and inflammation-related negative acute-phase response represented by albumin, the SII/Alb ratio aims to provide a more holistic prognostic biomarker approach compared with inflammatory indices alone. C-Reactive Protein/Albumin ratio The CRP/Alb ratio integrates CRP, a positive marker of the acute-phase response, with albumin, a negative acute-phase reactant that decreases during inflammation, thereby reflecting the severity of systemic inflammation and the patient’s biological reserve more comprehensively than CRP alone. In traumatic orthopedic conditions such as hip fractures, increased inflammatory response accompanied by hypoalbuminemia is closely associated with mortality and postoperative complications; therefore, the CRP/Alb ratio is used as a meaningful prognostic biomarker in this patient population (5). Similarly, CRP/Alb ratios were calculated at ICU admission using routine laboratory parameters according to the following formula: CRP/Alb = CRP (mg/L) / Alb (g/dL). The primary endpoint of the study was defined as in-hospital mortality. Patients were classified into survivor and mortality groups according to in-hospital mortality. In this context, sample size calculation was performed using the G*Power 3.1 software. For t-tests, assuming p<0.05, an effect size of 0.5, and a study power of 80%, a total of 128 patients were required to be included in the study. In this retrospective observational study, all patients who were followed during the 2-year period between the specified dates were included. Statistical analysis Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, USA; version 26.0). The normality of data distribution was assessed using the Shapiro–Wilk test, histograms, and analysis of skewness and kurtosis values. Descriptive statistics were expressed as number of patients, percentage, mean ± standard deviation, or median (interquartile range, IQR [Q1–Q3]) according to data distribution. For quantitative variables with normal distribution, the independent samples t-test was used, whereas the Mann–Whitney U test was applied for variables without normal distribution. Categorical variables were analyzed using the Pearson chi-square test or Fisher’s exact test, as appropriate. Multivariate logistic regression analysis was performed to identify independent predictors of mortality among variables that showed significant differences between the survivor and mortality groups. ROC curve analysis was conducted to determine the prognostic value of the SII/Alb and CRP/Alb ratios. A p-value <0.05 was considered statistically significant for all analyses. Results A total of 233 geriatric patients who were followed and treated in the ICU after hip fracture surgery between January 2023 and January 2025 were included in the study (Figure 1). The in-hospital mortality rate was 7.7% (n=18). The median age of the entire cohort was 81 (75–85) years, and 68.2% (n=159) were female. In the mortality group, median age (86 vs. 80 years, p=0.042) and the proportion of male patients (55.6% vs. 29.8%, p=0.024) were significantly higher. The proportion of patients with ASA physical status IV was significantly higher in the mortality group (33.3% vs. 5.1%, p<0.001), as was the median length of ICU stay (15 vs. 1 day, p<0.001). At ICU admission, median GCS scores were significantly lower (14 vs. 15, p=0.003), whereas APACHE-II scores were significantly higher (18 vs. 10, p<0.001) in the mortality group. The types of anesthesia administered to patients with hip fractures did not differ significantly between the groups (Table 1). At ICU admission, routine laboratory results showed that mean hemoglobin (9.2 vs. 10.3 g/dL, p=0.006), mean albumin (2.5 vs. 3.0 g/dL, p<0.001), and median lymphocyte counts (1.1 vs. 1.4, p=0.002) were significantly lower in the mortality group. In contrast, median CRP (54.6 vs. 18.2 mg/L, p=0.013), creatinine (1.0 vs. 0.8 mg/dL, p=0.017), and base excess values (4.5 vs. 2.1, p<0.001) were significantly higher in the mortality group. Additionally, among inflammatory biomarkers, median SII (4464 vs. 2253, p=0.001), SII/Alb ratio (1767 vs. 745, p<0.001), and CRP/Alb ratio (21.7 vs. 6.2, p=0.001) were significantly higher in the mortality group (Table 1). Hypertension was present in 69.1% (n=161) of the total population, neurocognitive disorders (stroke, Alzheimer’s disease, and Parkinson’s disease) in 40.3%, and diabetes mellitus in 34.3% (n=80). No significant differences in comorbid conditions were observed between the groups (Table 2). Multivariate regression analysis was performed for biomarkers and scoring systems that showed significant differences between groups in ICU-treated hip fracture patients, including the SII/Alb ratio, CRP/Alb ratio, SII, GCS, and APACHE-II scores. The Enter method was used in the multivariate regression analysis. SAR (OR=1.003, p=0.019), CAR (OR=1.077, p=0.010), and the APACHE-II score (OR=1.225, p<0.001) were identified as independent predictors of in-hospital mortality (Table 3). When the prognostic values of the scores that differed significantly between groups were evaluated using ROC curve analysis, the cut-off value for SII/Alb ratio was ≥1,036 with an area under the curve (AUC) of 0.794 (95% CI, 0.688–0.899); for CRP/Alb ratio, the cut-off value was ≥12 with an AUC of 0.727 (95% CI, 0.623–0.832); for SII, the cut-off value was ≥3,834 with an AUC of 0.736 (95% CI, 0.617–0.854); for APACHE-II, the cut-off value was ≥16 with an AUC of 0.873 (95% CI, 0.784–0.961); and for the GCS score, the cut-off value was ≤13 with an AUC of 0.687 (95% CI, 0.198–0.428) (Table 4). Discussion In this study conducted at a tertiary hospital, we found that biomarkers reflecting both inflammatory and nutritional status at admission were strongly associated with in-hospital mortality in critically ill geriatric patients with hip fractures who were followed in the ICU during the postoperative period. In the mortality group, CRP, SII, CRP/albumin, and particularly the SII/albumin ratio were significantly higher, whereas albumin and lymphocyte levels were markedly lower, suggesting that the systemic inflammatory response following hip fracture, together with concomitant immune suppression and malnutrition, adversely affects prognosis. Moreover, the identification of the SII/Alb ratio and the CRP/Alb ratio as independent predictors of in-hospital mortality alongside the APACHE-II score in multivariate analysis indicates that these parameters reflect not only inflammatory burden but also physiological reserve, thereby contributing to early risk stratification. These findings support the notion that, in critically ill geriatric patients with hip fractures, the prediction of short-term mortality should not rely solely on clinical scoring systems but should also incorporate simple and readily available biomarkers that provide a holistic assessment of inflammation and nutritional status. CRP is a fundamental acute-phase reactant that reflects the severity of the acute inflammatory response through interleukin-6–mediated hepatic synthesis and rises rapidly in the early period following trauma and surgery. Although CRP is one of the most widely used biomarkers reflecting the intensity of the acute inflammatory response after trauma and surgery, its prognostic power alone has been reported to be limited in the geriatric population due to age-related chronic inflammation, immunosenescence, and a high burden of comorbidities [12]. In geriatric patients with hip fractures, elevated CRP levels have been associated with the development of complications and increased mortality; however, chronic inflammation, comorbidity burden, and age-related immune dysfunction commonly observed in advanced age have been shown to limit the prognostic value of CRP when used in isolation [13]. To overcome this limitation, the CRP/alb ratio integrates the inflammatory burden with nutritional reserve into a single parameter, providing a stronger, more holistic prognostic assessment than CRP alone. Recent literature has demonstrated that CRP/alb ratio is an independent predictor of both early and late mortality in geriatric patients with hip fractures and exhibits higher AUC values than CRP [13–15]. While cut-off values around 14 have been reported to significantly predict 30-day mortality in CRP/alb ratio (12), other studies have reported a wide range of cut-off values, ranging from 11 to 29 [13–15]. This heterogeneity may be related to differences in patient populations and clinical severity. In our study, the ability of a CRP/alb ratio cut-off value ≥ 12 to predict in-hospital mortality, along with the identification of CRP/alb ratio as an independent predictor in multivariate analysis, indicates that CRP/alb ratio is a strong and clinically applicable biomarker for determining short-term prognosis, particularly in critically ill geriatric patients with hip fractures admitted to the ICU. These findings highlight the inadequacy of traditional approaches relying solely on CRP and support the benefit of evaluating inflammation in conjunction with albumin levels in geriatric patients with hip fractures. A substantial proportion of deaths following hip fracture have been shown to be related not to surgical technique but to early systemic complications and insufficient physiological reserve [16]. SII, which simultaneously reflects neutrophilia and thrombocytosis together with lymphopenia, provides an integrated assessment of inflammation and immune suppression and has recently been used for prognostic purposes in various patient populations [17,18]. In elderly patients, the acute inflammatory response triggered by fracture and surgical stress becomes more pronounced on a background of age-related immune dysfunction and chronic low-grade inflammation, thereby adversely affecting short-term prognosis [19]. Moreover, malnutrition and hypoalbuminemia, which are common in geriatric patients with hip fractures, are among the major factors that impair control of the inflammatory response and increase the risk of infection, organ dysfunction, and mortality [20]. Studies in geriatric patients with hip fractures have reported that elevated SII levels are associated with increased short- and long-term mortality [21]. Although the biological mechanisms linking SII to mortality have not been fully elucidated, they appear to be related to immune dysfunction and systemic inflammatory response. Following hip fracture, cytokine release increases, and neutrophil and macrophage accumulation occurs as a result of lymphocyte dysfunction. Injury, infection, or ischemia triggers a protective inflammatory response accompanied by thrombocytosis. In geriatric patients, reduced physiological reserve leads to an inadequate anti-inflammatory response against excessive proinflammatory cytokine release. This imbalance may result in prolonged systemic inflammation, organ dysfunction, and ultimately an increased risk of mortality. Thus, SII reflects not only the severity of inflammation but also the organism’s capacity for immune homeostasis. However, considering the high prevalence of hypoalbuminemia and malnutrition in the elderly population and their substantial impact on the intensity of the inflammatory response and clinical course, the prognostic sensitivity of SII when used alone may be limited. In this context, the significant association between the SII/albumin ratio and in-hospital mortality observed in our study highlights the importance of jointly evaluating the cellular inflammatory response and nutritional reserve. In our study, the SII/Alb ratio demonstrated a higher discriminative ability for predicting in-hospital mortality compared with the CRP/Alb ratio (AUC: 0.794 vs. 0.727), suggesting that the combined evaluation of inflammatory response and nutritional reserve may be superior to unidimensional biomarkers. Although the CRP/Alb ratio reflects prognosis by integrating the acute-phase response with hypoalbuminemia, it is primarily based on an inflammation marker related to hepatic synthesis. In contrast, the SII/Alb ratio provides a more comprehensive biological profile by jointly assessing albumin with the cellular inflammatory response, which reflects neutrophil- and platelet-mediated innate immune activation and lymphocyte suppression. Recent studies in critically ill patients have reported that SII-based indices offer greater accuracy in predicting mortality than CRP-based ratios [22]. Particularly in the elderly population, the frequent presence of immunosenescence, lymphopenia, and hypoalbuminemia may limit the prognostic sensitivity of CRP/Alb, which relies solely on the acute-phase response. Contemporary cohort studies in trauma and orthopedic surgery patients have demonstrated that SII and its derivatives, which reflect cellular inflammation, predict short-term mortality more strongly than CRP-based biomarkers [23,24]. Although SII alone has been reported to be associated with mortality in geriatric patients with hip fractures [25,26], studies investigating the prognostic impact of the SII/Alb ratio (combining cellular inflammation with nutritional reserve) remain extremely limited. This scarcity of evidence renders the superior prognostic performance of the SII/Alb ratio over the CRP/Alb ratio in our study clinically and biologically meaningful. Considering the high prevalence of hypoalbuminemia, lymphopenia, and immunosenescence in elderly patients, the SII/Alb ratio may more accurately reflect mortality risk than the CRP/Alb ratio, which represents only the acute-phase response. Therefore, our findings support that the SII/Alb ratio may represent not merely an alternative but potentially a superior prognostic biomarker to the CRP/Alb ratio in critically ill geriatric patients with hip fractures and may be useful for early risk stratification. This study has several limitations. First, the retrospective and single-center design limits the ability to establish causal relationships and reduces the generalizability of the findings. Second, the inclusion of only geriatric patients with hip fractures who were followed in the ICU during the postoperative period may have excluded patients with a milder clinical course, potentially introducing selection bias. Third, inflammatory biomarkers were evaluated using a single measurement obtained at ICU admission, and dynamic perioperative changes could not be assessed through serial measurements. In addition, albumin levels may be influenced by factors such as acute inflammatory response, fluid therapy, and hemodilution, and therefore may not accurately reflect true nutritional status. The effects of comorbidity burden and perioperative complications (e.g., sepsis or multiple organ failure) on inflammatory biomarkers could not be fully standardized. Finally, functional outcomes and long-term survival data beyond in-hospital mortality were not evaluated. Consequently, the present findings should be validated by prospective, multicenter studies including larger patient populations. Conclusion In conclusion, in critically ill geriatric patients with hip fractures who were followed in the ICU during the postoperative period, the admission SII/Alb and CRP/Alb ratios are useful and independent biomarkers for predicting in-hospital mortality. Notably, the higher discriminative ability of the SII/Alb ratio compared with the CRP/Alb ratio suggests that the combined assessment of cellular inflammation and nutritional reserve may be clinically valuable for early risk stratification. Abbreviations SII: Systemic immune inflammation index, Alb: Albumin, C-reactive protein: CRP, ICU: Intensive care unit, ROC: Receiver operating characteristic, APACHE-II: Acute physiology and chronic health evaluation-II, AUC: Area under curve, ASA: American Society of Anesthesiologist, IQR: interquartile range, GCS: Glasgow Coma Scale. Declarations Ethics approval and consent to participate This single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital (approval number: KAEK/2025.06.162, June 25, 2025) and the need for written informed consent was waived. Clinical trial number: Not applicable Funding Declaration: Not Applicable Consent for publication: Not Applicable Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no conflicts of interest. Authors’ contributions KA and ASS helped to design and conduct the study. KA analysed the data and approved the final manuscript. KA and ASS helped to design and conduct the study. KA and ASS and handed in the final manuscript. The authors read and approved the final manuscript Acknowledgements: Not Applicable References Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop. 2019;10(3):166-75. Dimet-Wiley A, Golovko G, Watowich SJ. One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study. JMIR Aging. 2022;5(1):e32683. Arslan K, Sultan Sahin A. Lactate, lactate clearance, and lactate-to-albumin ratio in predicting mortality in patients with critical polytrauma: A retrospective observational study. Medicine (Baltimore). 2024;103:49(e40704). 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Prognostic Value of Systemic Immune-Inflammation Index and Systemic Inflammatory Response Index on Functional Status and Mortality in Patients with Critical Acute Ischemic Stroke. Tohoku J Exp Med. 2025;265(2):91-7. Franceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018;14(10):576-90. Malafarina V, Reginster JY, Cabrerizo S, et al. Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients. 2018;10(5):555. Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021;21(1):155. Zhu S, Li H, Ou Z, Zheng M, Yuan W. Systemic Immune-Inflammation Index Outperforms Conventional Inflammatory Markers in Predicting Cardiovascular Outcomes in Heart Failure with Preserved Ejection Fraction. J Inflamm Res. 2026;19:1-11. Liang L, Su Q. Systemic immune-inflammation index and the short-term mortality of patients with sepsis: A meta-analysis. Biomol Biomed. 2025;25(4):798-809. Akboga MK, Inanc IH, Sabanoglu C, et al. Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome. Angiology. 2023;74(7):693-701. Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021;21(1):155. Tan S, Jiang Y, Qin K, et al. Systemic immune-inflammation index and 2-year all-cause mortality in elderly patients with hip fracture. Arch Gerontol Geriatr. 2025;129:105695. Tables Table 1. Patient clinical characteristics and laboratory data Variable All population ( n=233 ) Survivor group ( n= 215) Mortality group ( n=1 8) p-value Age (y) 81 (75-85) 80 (75-85) 86 (75-91) 0. 042 Sex , n (%) 0.024 Female 159 (68.2) 151 (70.2) 8 (44.4) Male 74 (31.8) 64 (29.8) 10 (55.6) ASA status <0.001 II 11 (4.7) 11 (5.1) 0 III 205 (88) 193 (89.8) 12 (66.7) IV 17 (7.3) 11 (5.1) 6 (33.3) Duration of ICU (days) 1 (1-3) 1 (1-3) 15 (2-24) <0.001 Laboratory parameters Hemoglobin (g/dL) 10.2±1.6 10.3±1.7 9.2±1.1 0.006 Albumin (g/dL) 3.0±0.4 3.0±0.4 2.5±0.5 <0.001 CRP ( mg/L) 19 (7.9-53.9) 18.2 (6.9-50.3) 54.6 (13.9-66.1) 0.013 Lenfocyte (10 9 /L) 1.3 (1.0-1.8) 1.4 (1.0-1.8) 1.1 (0.8-1.2) 0.002 SII 2384 (1440-3777) 2253 (1405-3579) 4464 (2484-6282) 0.001 SII/Albumin 771 (456-1307) 745 (440-1189) 1767 (115-2690) <0.001 CRP/Albumin 6.3 (2.5-17.9) 6.2 (2.3-16.6) 21.7 (6.2-25.4) 0.001 Creatinine (mg/dL) 0.8 (0.6-1.2) 0.8 (0.6-1.2) 1.0 (0.9-1.8) 0.017 Neutrophil ( 10 9 /L) 11.2 (8.6-14.9) 11.1 (8.5-14.8) 13.8 (9.6-17.7) 0.118 Platelets (10 9 /L) 285±110 281±111 333±81 0.056 Lactate ( mmol/L) 1.6 (1.2-2.3) 1.6 (1.2-2.2) 1.8 (1.2-3.1) 0.310 INR 1.11 (1.04-1.19) 1.11 (1.04-1.19) 1.21 (1.05-1.28) 0.058 Base deficit 2.4 (1.0-4.3) 2.1 (1.0-4.0) 4.5 (3.7-8.9) <0.001 Urea 49.3±19.1 49.0±20.3 55.8±14.1 0.168 GFR (mL/dk/1.73 m²) 68.6±19.1 69.2±23.6 62.1±13.3 0.210 ALT (U/L) 15 (10-22) 14 (10-21) 25 (11-35) 0.06 AST (U/L) 24 (18-32) 23 (18-32) 25 (16-29) 0.461 Scores GCS 15 (13-15) 15 (14-15) 14 (12-14) 0.003 APACHE-II 10 (8-13) 10 (8-13) 18 (15-28) <0.001 Anesthesia type Spinal anesthesia 54 (23.2) 49 (22.8) 5 (27.8) 0.574 Spinal anesthesia and peripheral nerve block* 148 (63.5) 140 (65.1) 8 (44.4) 0.08 Combined spinal-epidural anesthesia 9 (3.9) 7 (3.3) 2 (11.1) 0.147 General anesthesia and peripheral nerve block* 13 (5.6) 11 (5.1) 2 (11.1) 0.265 Data are expressed as number of patients, percentage, mean±standart deviation and median (interquartile range=Q1-Q3). ASA: American society of anesthesiologist, ICU : Intensive care unit, CRP: C-Reactive Protein, SII: Systemic immün-inflammation index, INR: International normalized ratio, GFR: Glomerular filtration rate, GCS : Glasgow coma scale, APACHE-II : Acute Physiology and Chronic Health Assessment-II Table 2 . Comorbid diseases Comorbidity, n (%) Overall ( n=226 ) Survivor group ( n= 207) Mortality group ( n=1 9) p-value Hypertension 161 (69.1) 147 (68.4) 14 (77.8) 0.407 Stroke/Alzheimer/Parkinson 94 (40.3) 84 (39.1) 10 (55.6) 0.171 Diabetes 80 (34.3) 72 (33.5) 8 (44.4) 0.347 CVD/HF 75 (32.2) 71 (33.0) 4 (22.2) 0.346 Asthma /COPD 30 (12.9) 26 (12.1) 4 (22.2) 0.262 CVD/HF: Coronary vascular disease/heart failure, COPD : Chronic obstructive pulmonary disease Table 3. Multivariate logistic regression analysis of mortality prediction Odds Ratio 95% CI (min-max) p-value SII/Alb 1.003 1.000-1.005 0.019 CRP/Alb 1.077 1.018-1.139 0.010 SII 0.999 0.998-1.000 0.051 APACHE-II 1.225 1.106-1.357 <0.001 GCS 1.003 0.638-1.577 0.989 CI: Confidence interval, SII/Alb: Systemic-immune inflammation index/albumin ratio, CRP/Alb: C-reactive protein/albumin ratio, SII: Systemic-immune inflammation index, APACHE-II : Acute Physiology and Chronic Health Assessment-II score, GCS : Glasgow coma scale score Table 4. Prognostic performance of scores and biomarkers Cut-off Sensitivity Specificity AUC (95% CI) SII/Alb 1036 0.833 0.693 0.794 (0.688-0.899) CRP/Alb 12 0.722 0.674 0.727 (0.623-0.832) SII 3834 0.667 0.791 0.736 (0.617-0.854) APACHE-II 16 0.778 0.912 0.873 (0.784-0.961) GCS 13 0.556 0.242 0.687 (0.198-0.428) AUC: Area under curve , SII/Alb: Systemic-immune inflammation index/albumin ratio, CRP/Alb: C-reactive protein/albumin ratio, APACHE-II : Acute Physiology and Chronic Health Assessment-II, GCS : Glasgow coma scale Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9227029","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621371416,"identity":"b2723080-a32e-4c23-9fee-2d0923e29dd1","order_by":0,"name":"Kadir ARSLAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACCQYGgwNgFjsQf2AAsw2I1MLMwMA4A64lAb8WBpgWZh5itEi2H954uILBLl++mfnZY5s/dxIb2Ju3STD+uIdTizRPWsHBMwzJlhsOs5kb57Y9S2zgOVYmwZBQjFOLHEOOwcEGBmYDA2YGM+nchsOJDRI5ZkAtuF0mx/8GpKXeQL6Z/Zu0xR+gFvk3+LVIS4BtOWzAcJjHTJqBDWQLD34tkjOeFRxsMDhuYHCYp0yyt+2ZcRtPWrFFQhpuLRLnkzd/bKioNpBvb98m8ePPHdl+9sMbb3ywwa0FApCjmw1EENIwCkbBKBgFowA/AAD0kE85u9XnawAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kadir","middleName":"","lastName":"ARSLAN","suffix":""},{"id":621371417,"identity":"bfc69b84-f784-48dd-971e-52b5fdb52223","order_by":1,"name":"Hale Cetin Arslan","email":"","orcid":"","institution":"University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hale","middleName":"Cetin","lastName":"Arslan","suffix":""},{"id":621371418,"identity":"367405f8-80f3-4a08-b88b-649beb2484dd","order_by":2,"name":"Ayca Sultan Sahin","email":"","orcid":"","institution":"University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ayca","middleName":"Sultan","lastName":"Sahin","suffix":""}],"badges":[],"createdAt":"2026-03-25 20:53:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9227029/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9227029/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107244887,"identity":"7df096f7-36e8-40cb-8ec0-1559a23727ae","added_by":"auto","created_at":"2026-04-19 07:56:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":130677,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;Legend not included with this version.\u003c/p\u003e","description":"","filename":"Figure1.Flowchartofthestudy.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9227029/v1/f14fc4fd70dfc35aa6eb7991.jpg"},{"id":107484174,"identity":"9b88b1c0-973f-4c42-a146-fd9d0b89bae1","added_by":"auto","created_at":"2026-04-22 02:31:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":815556,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9227029/v1/be228c03-884c-4398-a54b-9b0f3c5340e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship Between Systemic Immuno-Inflammation Index/Albumin Ratio and C- Reactive Protein/Albumin Ratio and In-Hospital Mortality in Geriatric Hip Fracture Patients: A Retrospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGeriatric hip fractures are among the leading causes of trauma-related morbidity and mortality in older adults. Despite advances in surgical techniques and perioperative care, early complications and the risk of death remain major challenges in clinical practice. Although a decline in mortality rates has been observed with the development of modern medicine, the 1-year mortality rate after hip fracture is still reported to be 17\u0026ndash;25% [1\u0026ndash;3]. In critically ill geriatric patients, a multisystem clinical condition emerges in which the fracture-triggered systemic stress response, inflammation, immobilization, and comorbidity burden converge. Therefore, early risk stratification using rapid and low-cost biomarkers capable of predicting short-term outcomes such as in-hospital mortality is of critical importance. This approach is also beneficial for anticipating the need for intensive care, perioperative optimization, and healthcare resource planning [4].\u003c/p\u003e \u003cp\u003eThe systemic inflammatory response following hip fracture and the accompanying tendency toward malnutrition and sarcopenia are among the main determinants of prognosis. The C-reactive protein/albumin ratio (CRP/Alb), which can be derived from routine blood tests, has gained increasing attention because it combines an inflammatory marker (CRP) with a nutritional/reserve indicator (albumin) in a single measurement. In the geriatric population, the CRP/Alb ratio has been reported to have both short- and long-term prognostic value [5,6]. In geriatric patients undergoing hemiarthroplasty for hip fracture, the CRP/Alb ratio has been shown to be an independent predictor of 1-year mortality [6]. On the other hand, the systemic immune-inflammation index (SII; platelet \u0026times; neutrophil / lymphocyte), calculated from complete blood count parameters, is a useful index reflecting both inflammatory activity and suppression of the immune response. SII has been suggested to have prognostic value in critically injured trauma patients and in patients with hip fractures [7,8].\u003c/p\u003e \u003cp\u003eIn critically ill geriatric patients with hip fractures, nutritional status is also known to have prognostic value [9]. Based on this, a single inflammatory marker may be insufficient to determine prognosis in elderly patients with hip fractures; therefore, it is considered that calculating SII in relation to albumin (SII/Alb), which integrates both inflammation and nutritional status, may provide a more comprehensive assessment [10]. Although only a limited number of studies have investigated the prognostic value of the SII/Alb ratio, there is a lack of sufficient evidence regarding its prognostic significance specifically in geriatric patients with hip fractures. Given the prominent role of both inflammation and the high prevalence of malnutrition in this population, we hypothesized that the SII/Alb ratio could influence postoperative outcomes in geriatric patients with hip fractures. Accordingly, the aim of this retrospective observational study was to evaluate the prognostic value of the admission SII/Alb and CRP/Alb ratios for in-hospital mortality in geriatric patients who underwent surgery for hip fracture and were subsequently followed in the intensive care unit (ICU) during the postoperative period.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients and Study Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational study was initiated after obtaining approval from the institutional ethics committee (date: 25.06.2025, KAEK/2025.06.162). The study was conducted in accordance with the principles of the Declaration of Helsinki. Patients who underwent surgery for hip fracture and were followed in the ICU during the postoperative period between January 2023 and January 2025 at the University of Health Sciences, İstanbul Kanuni Sultan S\u0026uuml;leyman Training and Research Hospital were included in the study. Patient data were obtained from the hospital information system and medical records.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were: (1) age \u0026ge;65 years; (2) undergoing surgery for hip fracture and being monitored in the ICU during the postoperative period.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria were: (1) trauma at a site other than the hip fracture; (2) chronic kidney disease requiring dialysis; (3) severe liver disease; (4) malignancy; (5) use of medications that may cause bone marrow suppression; (6) cardiovascular depression or cardiac arrest during the perioperative period; (7) a history of viral or bacterial infection within the previous two weeks; and (8) missing data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic data, American Society of Anesthesiologist (ASA) physical status, comorbidities, admission Glasgow Coma Scale (GCS) score, acute physiology and chronic health evaluation-II (APACHE-II) score, routine laboratory parameters, and in-hospital mortality were recorded for geriatric patients who underwent hemiarthroplasty or proximal femoral nailing for hip fracture and were followed in the ICU during the postoperative period. Patients were classified into survivor and mortality groups, and the data were compared between these groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSystemic immune-inflammatory index / Albumin ratio\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SII/Alb ratio combines the SII, which reflects systemic inflammatory burden, with serum albumin levels, which are inversely related to inflammation, thereby providing a more comprehensive prognostic biomarker than indicators of inflammation or nutritional status alone. In traumatic orthopedic conditions such as geriatric hip fractures, the interaction between the systemic inflammatory response and malnutrition plays a critical role in clinical outcomes, further enhancing the prognostic relevance of the SII/albumin ratio [11].\u003c/p\u003e\n\u003cp\u003eSII was calculated using complete blood count parameters obtained at ICU admission in the postoperative period as follows: SII = (platelet count \u0026times; neutrophil count) / lymphocyte count.\u003c/p\u003e\n\u003cp\u003eSubsequently, the SII/Alb ratio was calculated by dividing the SII value by the serum albumin level measured at the same time point: SII/Alb = SII / Alb (g/dL).\u003c/p\u003e\n\u003cp\u003eBy integrating the systemic inflammatory and immune response burden reflected by SII with the nutritional/reserve status and inflammation-related negative acute-phase response represented by albumin, the SII/Alb ratio aims to provide a more holistic prognostic biomarker approach compared with inflammatory indices alone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC-Reactive Protein/Albumin ratio\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CRP/Alb ratio integrates CRP, a positive marker of the acute-phase response, with albumin, a negative acute-phase reactant that decreases during inflammation, thereby reflecting the severity of systemic inflammation and the patient\u0026rsquo;s biological reserve more comprehensively than CRP alone. In traumatic orthopedic conditions such as hip fractures, increased inflammatory response accompanied by hypoalbuminemia is closely associated with mortality and postoperative complications; therefore, the CRP/Alb ratio is used as a meaningful prognostic biomarker in this patient population (5). Similarly, CRP/Alb ratios were calculated at ICU admission using routine laboratory parameters according to the following formula:\u003cbr\u003e\u0026nbsp;CRP/Alb = CRP (mg/L) / Alb (g/dL).\u003c/p\u003e\n\u003cp\u003eThe primary endpoint of the study was defined as in-hospital mortality. Patients were classified into survivor and mortality groups according to in-hospital mortality. In this context, sample size calculation was performed using the G*Power 3.1 software. For t-tests, assuming p\u0026lt;0.05, an effect size of 0.5, and a study power of 80%, a total of 128 patients were required to be included in the study. In this retrospective observational study, all patients who were followed during the 2-year period between the specified dates were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS software (SPSS Inc., Chicago, USA; version 26.0). The normality of data distribution was assessed using the Shapiro\u0026ndash;Wilk test, histograms, and analysis of skewness and kurtosis values. Descriptive statistics were expressed as number of patients, percentage, mean \u0026plusmn; standard deviation, or median (interquartile range, IQR [Q1\u0026ndash;Q3]) according to data distribution. For quantitative variables with normal distribution, the independent samples t-test was used, whereas the Mann\u0026ndash;Whitney U test was applied for variables without normal distribution. Categorical variables were analyzed using the Pearson chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. Multivariate logistic regression analysis was performed to identify independent predictors of mortality among variables that showed significant differences between the survivor and mortality groups. ROC curve analysis was conducted to determine the prognostic value of the SII/Alb and CRP/Alb ratios. A p-value \u0026lt;0.05 was considered statistically significant for all analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 233 geriatric patients who were followed and treated in the ICU after hip fracture surgery between January 2023 and January 2025 were included in the study (Figure 1). The in-hospital mortality rate was 7.7% (n=18). The median age of the entire cohort was 81 (75\u0026ndash;85) years, and 68.2% (n=159) were female. In the mortality group, median age (86 vs. 80 years, p=0.042) and the proportion of male patients (55.6% vs. 29.8%, p=0.024) were significantly higher. The proportion of patients with ASA physical status IV was significantly higher in the mortality group (33.3% vs. 5.1%, p\u0026lt;0.001), as was the median length of ICU stay (15 vs. 1 day, p\u0026lt;0.001). At ICU admission, median GCS scores were significantly lower (14 vs. 15, p=0.003), whereas APACHE-II scores were significantly higher (18 vs. 10, p\u0026lt;0.001) in the mortality group. The types of anesthesia administered to patients with hip fractures did not differ significantly between the groups (Table 1).\u003c/p\u003e\n\u003cp\u003eAt ICU admission, routine laboratory results showed that mean hemoglobin (9.2 vs. 10.3 g/dL, p=0.006), mean albumin (2.5 vs. 3.0 g/dL, p\u0026lt;0.001), and median lymphocyte counts (1.1 vs. 1.4, p=0.002) were significantly lower in the mortality group. In contrast, median CRP (54.6 vs. 18.2 mg/L, p=0.013), creatinine (1.0 vs. 0.8 mg/dL, p=0.017), and base excess values (4.5 vs. 2.1, p\u0026lt;0.001) were significantly higher in the mortality group. Additionally, among inflammatory biomarkers, median SII (4464 vs. 2253, p=0.001), SII/Alb ratio (1767 vs. 745, p\u0026lt;0.001), and CRP/Alb ratio (21.7 vs. 6.2, p=0.001) were significantly higher in the mortality group (Table 1).\u003c/p\u003e\n\u003cp\u003eHypertension was present in 69.1% (n=161) of the total population, neurocognitive disorders (stroke, Alzheimer\u0026rsquo;s disease, and Parkinson\u0026rsquo;s disease) in 40.3%, and diabetes mellitus in 34.3% (n=80). No significant differences in comorbid conditions were observed between the groups (Table 2).\u003c/p\u003e\n\u003cp\u003eMultivariate regression analysis was performed for biomarkers and scoring systems that showed significant differences between groups in ICU-treated hip fracture patients, including the SII/Alb ratio, CRP/Alb ratio, SII, GCS, and APACHE-II scores. The Enter method was used in the multivariate regression analysis. SAR (OR=1.003, p=0.019), CAR (OR=1.077, p=0.010), and the APACHE-II score (OR=1.225, p\u0026lt;0.001) were identified as independent predictors of in-hospital mortality (Table 3).\u003c/p\u003e\n\u003cp\u003eWhen the prognostic values of the scores that differed significantly between groups were evaluated using ROC curve analysis, the cut-off value for SII/Alb ratio was \u0026ge;1,036 with an area under the curve (AUC) of 0.794 (95% CI, 0.688\u0026ndash;0.899); for CRP/Alb ratio, the cut-off value was \u0026ge;12 with an AUC of 0.727 (95% CI, 0.623\u0026ndash;0.832); for SII, the cut-off value was \u0026ge;3,834 with an AUC of 0.736 (95% CI, 0.617\u0026ndash;0.854); for APACHE-II, the cut-off value was \u0026ge;16 with an AUC of 0.873 (95% CI, 0.784\u0026ndash;0.961); and for the GCS score, the cut-off value was \u0026le;13 with an AUC of 0.687 (95% CI, 0.198\u0026ndash;0.428) (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study conducted at a tertiary hospital, we found that biomarkers reflecting both inflammatory and nutritional status at admission were strongly associated with in-hospital mortality in critically ill geriatric patients with hip fractures who were followed in the ICU during the postoperative period. In the mortality group, CRP, SII, CRP/albumin, and particularly the SII/albumin ratio were significantly higher, whereas albumin and lymphocyte levels were markedly lower, suggesting that the systemic inflammatory response following hip fracture, together with concomitant immune suppression and malnutrition, adversely affects prognosis. Moreover, the identification of the SII/Alb ratio and the CRP/Alb ratio as independent predictors of in-hospital mortality alongside the APACHE-II score in multivariate analysis indicates that these parameters reflect not only inflammatory burden but also physiological reserve, thereby contributing to early risk stratification. These findings support the notion that, in critically ill geriatric patients with hip fractures, the prediction of short-term mortality should not rely solely on clinical scoring systems but should also incorporate simple and readily available biomarkers that provide a holistic assessment of inflammation and nutritional status.\u003c/p\u003e \u003cp\u003eCRP is a fundamental acute-phase reactant that reflects the severity of the acute inflammatory response through interleukin-6\u0026ndash;mediated hepatic synthesis and rises rapidly in the early period following trauma and surgery. Although CRP is one of the most widely used biomarkers reflecting the intensity of the acute inflammatory response after trauma and surgery, its prognostic power alone has been reported to be limited in the geriatric population due to age-related chronic inflammation, immunosenescence, and a high burden of comorbidities [12]. In geriatric patients with hip fractures, elevated CRP levels have been associated with the development of complications and increased mortality; however, chronic inflammation, comorbidity burden, and age-related immune dysfunction commonly observed in advanced age have been shown to limit the prognostic value of CRP when used in isolation [13]. To overcome this limitation, the CRP/alb ratio integrates the inflammatory burden with nutritional reserve into a single parameter, providing a stronger, more holistic prognostic assessment than CRP alone. Recent literature has demonstrated that CRP/alb ratio is an independent predictor of both early and late mortality in geriatric patients with hip fractures and exhibits higher AUC values than CRP [13\u0026ndash;15]. While cut-off values around 14 have been reported to significantly predict 30-day mortality in CRP/alb ratio (12), other studies have reported a wide range of cut-off values, ranging from 11 to 29 [13\u0026ndash;15]. This heterogeneity may be related to differences in patient populations and clinical severity. In our study, the ability of a CRP/alb ratio cut-off value\u0026thinsp;\u0026ge;\u0026thinsp;12 to predict in-hospital mortality, along with the identification of CRP/alb ratio as an independent predictor in multivariate analysis, indicates that CRP/alb ratio is a strong and clinically applicable biomarker for determining short-term prognosis, particularly in critically ill geriatric patients with hip fractures admitted to the ICU. These findings highlight the inadequacy of traditional approaches relying solely on CRP and support the benefit of evaluating inflammation in conjunction with albumin levels in geriatric patients with hip fractures.\u003c/p\u003e \u003cp\u003eA substantial proportion of deaths following hip fracture have been shown to be related not to surgical technique but to early systemic complications and insufficient physiological reserve [16]. SII, which simultaneously reflects neutrophilia and thrombocytosis together with lymphopenia, provides an integrated assessment of inflammation and immune suppression and has recently been used for prognostic purposes in various patient populations [17,18]. In elderly patients, the acute inflammatory response triggered by fracture and surgical stress becomes more pronounced on a background of age-related immune dysfunction and chronic low-grade inflammation, thereby adversely affecting short-term prognosis [19]. Moreover, malnutrition and hypoalbuminemia, which are common in geriatric patients with hip fractures, are among the major factors that impair control of the inflammatory response and increase the risk of infection, organ dysfunction, and mortality [20]. Studies in geriatric patients with hip fractures have reported that elevated SII levels are associated with increased short- and long-term mortality [21]. Although the biological mechanisms linking SII to mortality have not been fully elucidated, they appear to be related to immune dysfunction and systemic inflammatory response. Following hip fracture, cytokine release increases, and neutrophil and macrophage accumulation occurs as a result of lymphocyte dysfunction. Injury, infection, or ischemia triggers a protective inflammatory response accompanied by thrombocytosis. In geriatric patients, reduced physiological reserve leads to an inadequate anti-inflammatory response against excessive proinflammatory cytokine release. This imbalance may result in prolonged systemic inflammation, organ dysfunction, and ultimately an increased risk of mortality. Thus, SII reflects not only the severity of inflammation but also the organism\u0026rsquo;s capacity for immune homeostasis. However, considering the high prevalence of hypoalbuminemia and malnutrition in the elderly population and their substantial impact on the intensity of the inflammatory response and clinical course, the prognostic sensitivity of SII when used alone may be limited. In this context, the significant association between the SII/albumin ratio and in-hospital mortality observed in our study highlights the importance of jointly evaluating the cellular inflammatory response and nutritional reserve.\u003c/p\u003e \u003cp\u003eIn our study, the SII/Alb ratio demonstrated a higher discriminative ability for predicting in-hospital mortality compared with the CRP/Alb ratio (AUC: 0.794 vs. 0.727), suggesting that the combined evaluation of inflammatory response and nutritional reserve may be superior to unidimensional biomarkers. Although the CRP/Alb ratio reflects prognosis by integrating the acute-phase response with hypoalbuminemia, it is primarily based on an inflammation marker related to hepatic synthesis. In contrast, the SII/Alb ratio provides a more comprehensive biological profile by jointly assessing albumin with the cellular inflammatory response, which reflects neutrophil- and platelet-mediated innate immune activation and lymphocyte suppression. Recent studies in critically ill patients have reported that SII-based indices offer greater accuracy in predicting mortality than CRP-based ratios [22]. Particularly in the elderly population, the frequent presence of immunosenescence, lymphopenia, and hypoalbuminemia may limit the prognostic sensitivity of CRP/Alb, which relies solely on the acute-phase response. Contemporary cohort studies in trauma and orthopedic surgery patients have demonstrated that SII and its derivatives, which reflect cellular inflammation, predict short-term mortality more strongly than CRP-based biomarkers [23,24]. Although SII alone has been reported to be associated with mortality in geriatric patients with hip fractures [25,26], studies investigating the prognostic impact of the SII/Alb ratio (combining cellular inflammation with nutritional reserve) remain extremely limited. This scarcity of evidence renders the superior prognostic performance of the SII/Alb ratio over the CRP/Alb ratio in our study clinically and biologically meaningful. Considering the high prevalence of hypoalbuminemia, lymphopenia, and immunosenescence in elderly patients, the SII/Alb ratio may more accurately reflect mortality risk than the CRP/Alb ratio, which represents only the acute-phase response. Therefore, our findings support that the SII/Alb ratio may represent not merely an alternative but potentially a superior prognostic biomarker to the CRP/Alb ratio in critically ill geriatric patients with hip fractures and may be useful for early risk stratification.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the retrospective and single-center design limits the ability to establish causal relationships and reduces the generalizability of the findings. Second, the inclusion of only geriatric patients with hip fractures who were followed in the ICU during the postoperative period may have excluded patients with a milder clinical course, potentially introducing selection bias. Third, inflammatory biomarkers were evaluated using a single measurement obtained at ICU admission, and dynamic perioperative changes could not be assessed through serial measurements. In addition, albumin levels may be influenced by factors such as acute inflammatory response, fluid therapy, and hemodilution, and therefore may not accurately reflect true nutritional status. The effects of comorbidity burden and perioperative complications (e.g., sepsis or multiple organ failure) on inflammatory biomarkers could not be fully standardized. Finally, functional outcomes and long-term survival data beyond in-hospital mortality were not evaluated. Consequently, the present findings should be validated by prospective, multicenter studies including larger patient populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, in critically ill geriatric patients with hip fractures who were followed in the ICU during the postoperative period, the admission SII/Alb and CRP/Alb ratios are useful and independent biomarkers for predicting in-hospital mortality. Notably, the higher discriminative ability of the SII/Alb ratio compared with the CRP/Alb ratio suggests that the combined assessment of cellular inflammation and nutritional reserve may be clinically valuable for early risk stratification.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSII: Systemic immune inflammation index, Alb: Albumin, C-reactive protein: CRP, ICU: Intensive care unit, ROC: Receiver operating characteristic, APACHE-II: Acute physiology and chronic health evaluation-II, AUC: Area under curve, ASA: American Society of Anesthesiologist, IQR: interquartile range, GCS: Glasgow Coma Scale.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center retrospective observational study was approved by the Institutional Review Board at University of Health Sciences, Istanbul Kanuni Sultan S\u0026uuml;leyman Training and Research Hospital (approval number:\u0026nbsp;KAEK/2025.06.162, June 25, 2025) and the need for written informed consent was waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKA and ASS helped to design and conduct the study. KA analysed the data and approved the final manuscript. KA and ASS helped to design and conduct the study. KA and ASS and handed in the final manuscript. The authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDowney C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop. 2019;10(3):166-75.\u003c/li\u003e\n\u003cli\u003eDimet-Wiley A, Golovko G, Watowich SJ. One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study. JMIR Aging. 2022;5(1):e32683.\u003c/li\u003e\n\u003cli\u003eArslan K, Sultan Sahin A. Lactate, lactate clearance, and lactate-to-albumin ratio in predicting mortality in patients with critical polytrauma: A retrospective observational study. Medicine (Baltimore). 2024;103:49(e40704).\u003c/li\u003e\n\u003cli\u003eAndaloro S, Cacciatore S, Risoli A, et al. Hip Fracture as a Systemic Disease in Older Adults: A Narrative Review on Multisystem Implications and Management. Med Sci (Basel). 2025;13(3):89.\u003c/li\u003e\n\u003cli\u003eAlpar S, Yılmaz S. Association Between C-reactive Protein to Albumin Ratio and Mortality in Geriatric Hip Fracture Patients. Anatol J Gen Med Res. 2025;35(2):185-91. \u003c/li\u003e\n\u003cli\u003eCapkin S, Guler S, Ozmanevra R. C-Reactive Protein to Albumin Ratio May Predict Mortality for Elderly Population Who Undergo Hemiarthroplasty Due to Hip Fracture. J Invest Surg. 2021;34(11):1272-7.\u003c/li\u003e\n\u003cli\u003eArslan K, Sahin AS. Prognostic value of systemic immuneinflammation index, neutrophil-lymphocyte ratio, and thrombocyte-lymphocyte ratio in critically ill patients with moderate to severe traumatic brain injury. Medicine (Baltimore). 2024;103:29(e39007).\u003c/li\u003e\n\u003cli\u003eTan S, Jiang Y, Qin K, Luo Y, Liang D, Xie Y, Cui X, Wang J, Lyu H, Zhang L. Systemic immune-inflammation index and 2-year all-cause mortality in elderly patients with hip fracture. Arch Gerontol Geriatr. 2025;129:105695\u003c/li\u003e\n\u003cli\u003eArslan K, Celik S, Cetin Arslan H, Sahin AS, Genc Y, Erturk C. Predictive value of prognostic nutritional index on postoperative intensive care requirement and mortality in geriatric hip fracture patients. North Clin Istanb. 2024;11(3):249\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eLu J, Wei F, Sun J, et al. Systemic immune-inflammation index to albumin (SII/ALB) ratio as a novel dual-dimensional powerful predictor for hip fractures in elderly females with diabetes: a postmenopausal longitudinal cohort study. BMC Endocr Disord. 2025;25(1):57. \u003c/li\u003e\n\u003cli\u003eLiu ZJ, Li GH, Wang JX, et al. Prognostic value of the systemic immune-inflammation index in critically ill elderly patients with hip fracture: evidence from MIMIC (2008-2019). Front Med (Lausanne). 2024;11:1408371.\u003c/li\u003e\n\u003cli\u003eCacciola G, Mancino F, Holzer LA, et al. Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study. J Clin Med. 2023;12(13):4544.\u003c/li\u003e\n\u003cli\u003eKaya O, Efendioglu EM. Association of preoperative C-reactive protein to albumin ratio and mortality in elderly patients with hip fractures: A cross-sectional study. Ulus Travma Acil Cerrahi Derg. 2024;30(12):907-13.\u003c/li\u003e\n\u003cli\u003eAydın A, Ka\u0026ccedil;maz O. CRP/albumin ratio in predicting 1-year mortality in elderly patients undergoing hip fracture surgery. Eur Rev Med Pharmacol Sci. 2023;27(18):8438-46.\u003c/li\u003e\n\u003cli\u003eBalta O, Altınayak H, G\u0026uuml;rler Balta M, et al. Can C-reactive protein-based biomarkers be used as predictive of 30-day mortality in elderly hip fractures?A retrospective study. Ulus Travma Acil Cerrahi Derg. 2022;28(6):849-56.\u003c/li\u003e\n\u003cli\u003eVeronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458-60. \u003c/li\u003e\n\u003cli\u003eKou J, Huang J, Li J, Wu Z, Ni L. Systemic immune-inflammation index predicts prognosis and responsiveness to immunotherapy in cancer patients: a systematic review and meta‑analysis. Clin Exp Med. 2023;23(7):3895-3905.\u003c/li\u003e\n\u003cli\u003eArslan K, Sahin AS. Prognostic Value of Systemic Immune-Inflammation Index and Systemic Inflammatory Response Index on Functional Status and Mortality in Patients with Critical Acute Ischemic Stroke. Tohoku J Exp Med. 2025;265(2):91-7.\u003c/li\u003e\n\u003cli\u003eFranceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018;14(10):576-90.\u003c/li\u003e\n\u003cli\u003eMalafarina V, Reginster JY, Cabrerizo S, et al. Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients. 2018;10(5):555.\u003c/li\u003e\n\u003cli\u003eWang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021;21(1):155.\u003c/li\u003e\n\u003cli\u003eZhu S, Li H, Ou Z, Zheng M, Yuan W. Systemic Immune-Inflammation Index Outperforms Conventional Inflammatory Markers in Predicting Cardiovascular Outcomes in Heart Failure with Preserved Ejection Fraction. J Inflamm Res. 2026;19:1-11.\u003c/li\u003e\n\u003cli\u003eLiang L, Su Q. Systemic immune-inflammation index and the short-term mortality of patients with sepsis: A meta-analysis. Biomol Biomed. 2025;25(4):798-809. \u003c/li\u003e\n\u003cli\u003eAkboga MK, Inanc IH, Sabanoglu C, et al. Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome. Angiology. 2023;74(7):693-701. \u003c/li\u003e\n\u003cli\u003eWang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr. 2021;21(1):155.\u003c/li\u003e\n\u003cli\u003eTan S, Jiang Y, Qin K, et al. Systemic immune-inflammation index and 2-year all-cause mortality in elderly patients with hip fracture. Arch Gerontol Geriatr. 2025;129:105695.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003ePatient clinical characteristics and laboratory data\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=233\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivor group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=\u003c/strong\u003e\u003cstrong\u003e215)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=1\u003c/strong\u003e\u003cstrong\u003e8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y)\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e81 (75-85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e80 (75-85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e86 (75-91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.\u003c/strong\u003e\u003cstrong\u003e042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003cstrong\u003e, n (%)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003eFemale \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e159 (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e151 (70.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e8 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003eMale \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e74 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e64 (29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e10 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA status \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 63.2399%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u0026nbsp;II \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e11 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e11 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u0026nbsp;III \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e205 (88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e193 (89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e12 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u0026nbsp;IV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e17 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e11 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e6 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of ICU (days) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e1 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e15 (2-24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 73.5202%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin (g/dL) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e10.2\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e10.3\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e9.2\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlbumin (g/dL) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e3.0\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e3.0\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e2.5\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP (\u003c/strong\u003e\u003cstrong\u003emg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e19 (7.9-53.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e18.2 (6.9-50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e54.6 (13.9-66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLenfocyte\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e1.3 (1.0-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.4 (1.0-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.1 (0.8-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e2384 (1440-3777)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e2253 (1405-3579)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e4464 (2484-6282)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSII/Albumin\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e771 (456-1307)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e745 (440-1189)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1767 (115-2690)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP/Albumin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e6.3 (2.5-17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e6.2 (2.3-16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e21.7 (6.2-25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCreatinine (mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e0.8 (0.6-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e0.8 (0.6-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.0 (0.9-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutrophil (\u003c/strong\u003e\u003cstrong\u003e10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e11.2 (8.6-14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e11.1 (8.5-14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e13.8 (9.6-17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlatelets (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e285\u0026plusmn;110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e281\u0026plusmn;111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e333\u0026plusmn;81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLactate (\u003c/strong\u003e\u003cstrong\u003emmol/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e1.6 (1.2-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.6 (1.2-2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.8 (1.2-3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINR \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e1.11 (1.04-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.11 (1.04-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e1.21 (1.05-1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBase deficit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e2.4 (1.0-4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e2.1 (1.0-4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e4.5 (3.7-8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e49.3\u0026plusmn;19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e49.0\u0026plusmn;20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e55.8\u0026plusmn;14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGFR (mL/dk/1.73 m\u0026sup2;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e68.6\u0026plusmn;19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e69.2\u0026plusmn;23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e62.1\u0026plusmn;13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALT (U/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e15 (10-22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e14 (10-21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e25 (11-35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAST (U/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e24 (18-32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e23 (18-32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e25 (16-29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 73.5202%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGCS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e15 (13-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e15 (14-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e14 (12-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPACHE-II\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e10 (8-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e10 (8-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e18 (15-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnesthesia type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 73.5202%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003eSpinal anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e54 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e49 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e5 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003eSpinal anesthesia and peripheral nerve block*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e148 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e140 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e8 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003eCombined spinal-epidural anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e9 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e7 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.4798%;\"\u003e\n \u003cp\u003eGeneral anesthesia and peripheral nerve block*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1184%;\"\u003e\n \u003cp\u003e13 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e11 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.2804%;\"\u003e\n \u003cp\u003e0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are expressed as number of patients, percentage, mean\u0026plusmn;standart deviation and median (interquartile range=Q1-Q3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eASA:\u003c/strong\u003e American society of anesthesiologist, \u003cstrong\u003eICU\u003c/strong\u003e: Intensive care unit, \u003cstrong\u003eCRP:\u0026nbsp;\u003c/strong\u003eC-Reactive Protein, \u003cstrong\u003eSII:\u003c/strong\u003e Systemic imm\u0026uuml;n-inflammation index, \u003cstrong\u003eINR:\u0026nbsp;\u003c/strong\u003eInternational normalized ratio, \u003cstrong\u003eGFR:\u0026nbsp;\u003c/strong\u003eGlomerular filtration rate, \u003cstrong\u003eGCS\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eGlasgow coma scale,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAPACHE-II\u003c/strong\u003e: Acute Physiology and Chronic Health Assessment-II\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eComorbid diseases\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8411%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003en (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1994%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=226\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivor group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=\u003c/strong\u003e\u003cstrong\u003e207)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003en=1\u003c/strong\u003e\u003cstrong\u003e9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.838%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8411%;\"\u003e\n \u003cp\u003eHypertension \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1994%;\"\u003e\n \u003cp\u003e161 (69.1) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e147 (68.4) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e14 (77.8) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.838%;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8411%;\"\u003e\n \u003cp\u003eStroke/Alzheimer/Parkinson \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1994%;\"\u003e\n \u003cp\u003e94 (40.3) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e84 (39.1) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e10 (55.6) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.838%;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8411%;\"\u003e\n \u003cp\u003eDiabetes \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1994%;\"\u003e\n \u003cp\u003e80 (34.3) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e72 (33.5) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e\u0026nbsp; 8 (44.4) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.838%;\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8411%;\"\u003e\n \u003cp\u003eCVD/HF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1994%;\"\u003e\n \u003cp\u003e75 (32.2) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e71 (33.0) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e4 (22.2) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.838%;\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.8411%;\"\u003e\n \u003cp\u003eAsthma /COPD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1994%;\"\u003e\n \u003cp\u003e30 (12.9) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e26 (12.1) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5607%;\"\u003e\n \u003cp\u003e4 (22.2) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.838%;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCVD/HF:\u003c/strong\u003e\u0026nbsp; Coronary vascular disease/heart failure, \u003cstrong\u003eCOPD\u003c/strong\u003e: Chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eMultivariate logistic regression analysis of mortality prediction\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;95%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(min-max)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3422%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSII/Alb\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e1.003 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e1.000-1.005\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3422%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP/Alb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e1.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e1.018-1.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3422%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e0.998-1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3422%;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPACHE-II\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e1.225 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e1.106-1.357 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3422%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGCS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e1.003 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e0.638-1.577\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3422%;\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCI:\u0026nbsp;\u003c/strong\u003eConfidence interval, \u003cstrong\u003eSII/Alb:\u0026nbsp;\u003c/strong\u003eSystemic-immune inflammation index/albumin ratio, \u003cstrong\u003eCRP/Alb:\u0026nbsp;\u003c/strong\u003eC-reactive protein/albumin ratio, \u003cstrong\u003eSII:\u003c/strong\u003e Systemic-immune inflammation index, \u003cstrong\u003eAPACHE-II\u003c/strong\u003e: Acute Physiology and Chronic Health Assessment-II score, \u003cstrong\u003eGCS\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eGlasgow coma scale score\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003ePrognostic performance of scores and biomarkers\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3779%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCut-off \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Specificity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6873%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSII/Alb\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3779%;\"\u003e\n \u003cp\u003e1036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6873%;\"\u003e\n \u003cp\u003e0.794 (0.688-0.899)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP/Alb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3779%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6873%;\"\u003e\n \u003cp\u003e0.727 (0.623-0.832)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3779%;\"\u003e\n \u003cp\u003e3834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6873%;\"\u003e\n \u003cp\u003e0.736 (0.617-0.854)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPACHE-II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3779%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6873%;\"\u003e\n \u003cp\u003e0.873 (0.784-0.961)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0586%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGCS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.3779%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9381%;\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6873%;\"\u003e\n \u003cp\u003e0.687 (0.198-0.428)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAUC:\u0026nbsp;\u003c/strong\u003eArea under curve\u003cstrong\u003e, SII/Alb:\u0026nbsp;\u003c/strong\u003eSystemic-immune inflammation index/albumin ratio, \u003cstrong\u003eCRP/Alb:\u0026nbsp;\u003c/strong\u003eC-reactive protein/albumin ratio, \u003cstrong\u003eAPACHE-II\u003c/strong\u003e: Acute Physiology and Chronic Health Assessment-II, \u003cstrong\u003eGCS\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eGlasgow coma scale\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hip Fractures, systemic immune-inflammation index, critically ill elderly patients, C-reactive protein, albumin, prognostic value, in-hospital mortality","lastPublishedDoi":"10.21203/rs.3.rs-9227029/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9227029/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGeriatric hip fractures are one of the leading causes of morbidity and mortality. The systemic inflammatory response following hip fracture and the accompanying malnutrition are influential in prognosis. The aim of this study is to investigate the relationship between the systemic immune inflammation index/albumin (SII/Alb) ratio and the C-reactive protein/albumin (CRP/Alb) ratio at admission and in-hospital mortality in patients who underwent surgery for geriatric hip fracture and were followed up in the intensive care unit (ICU) in the postoperative period.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective observational study, conducted at a tertiary hospital between January 2023 and January 2025, included patients who underwent surgery for hip fracture and were followed in the ICU postoperatively. Demographic data, comorbidities, ICU scores, and routine laboratory results at admission were recorded. SII/Alb and CRP/Alb ratios were calculated. The primary endpoint was defined as in-hospital mortality. Multivariate logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) analyses were used to assess prognostic performance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 233 patients were included in the study. The in-hospital mortality rate was 7.7%. Age and male sex were significantly higher in the mortality group (p\u0026thinsp;=\u0026thinsp;0.042 and p\u0026thinsp;=\u0026thinsp;0.024, respectively). Median SII (4464 vs. 2253, p\u0026thinsp;=\u0026thinsp;0.001), SII/Alb (1767 vs. 745, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and CRP/Alb (21.7 vs. 6.2, p\u0026thinsp;=\u0026thinsp;0.001) values were significantly higher in the mortality group. In multivariate regression analysis, SII/Alb (OR\u0026thinsp;=\u0026thinsp;1.003; p\u0026thinsp;=\u0026thinsp;0.019), CRP/Alb (OR\u0026thinsp;=\u0026thinsp;1.077; p\u0026thinsp;=\u0026thinsp;0.010), and the acute physiology and chronic health evaluation-II (APACHE-II) score (OR\u0026thinsp;=\u0026thinsp;1.225; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were identified as independent predictors of in-hospital mortality. ROC analysis showed that the area under the curve (AUC) was 0.873 for APACHE-II, 0.794 for SII/Alb, 0.736 for SII, and 0.727 for the CRP/Alb ratio.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn critically ill geriatric patients with hip fractures, the SII/Alb and CRP/Alb ratios at admission are effective and easily accessible biomarkers for predicting in-hospital mortality. These biomarkers may be useful for early risk stratification and clinical decision-making.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Systemic Immuno-Inflammation Index/Albumin Ratio and C- Reactive Protein/Albumin Ratio and In-Hospital Mortality in Geriatric Hip Fracture Patients: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 07:55:55","doi":"10.21203/rs.3.rs-9227029/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-11T13:35:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T12:43:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75157409172007569937911534071395208552","date":"2026-04-21T14:40:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T10:02:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266270113528383503046104802597628058616","date":"2026-04-11T08:06:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T13:19:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-28T06:40:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T06:40:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2026-03-25T20:46:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be38c194-7d06-447f-b887-9f28b3d5dc0b","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-11T13:35:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T12:43:05+00:00","index":20,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T09:38:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 07:55:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9227029","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9227029","identity":"rs-9227029","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}