Neutrophil Profiling May Aid Surgical and Palliative Care Decisions in Elderly Hip Fracture Patients: Study Shows

Those in higher inflammation categories had elevated leukocyte counts, increased C-reactive protein levels, more infections, and an 83% 30-day palliative care mortality rate, compared to 50% in the low-inflammation group. These findings suggest that assessing systemic inflammation may help tailor treatment strategies and improve care for this high-risk population.

Geriatric patients with hip fractures often face a high risk of complications following surgery, making timely and accurate clinical decision-making essential. A previous pilot study demonstrated that analyzing neutrophils—key immune cells—can help assess systemic inflammation in these patients, offering a potential tool to predict outcomes more effectively.

Building on this, E. J. de Fraiture, Department of Trauma Surgery, UMC Utrecht, Utrecht, Netherlands, and colleagues aimed to explore the relationship between neutrophil inflammation categories and clinical outcomes in a larger group of elderly hip fracture patients.

For this purpose, the researchers conducted a prospective cohort study that collected blood samples from elderly patients soon after they experienced a hip fracture. They also included healthy older adults as a control group. The neutrophils in the blood were analyzed and categorized on a scale from 0 to 6, representing levels of inflammation ranging from none to severe. These inflammation categories were then compared with the patient's clinical outcomes to understand how systemic inflammation might impact recovery and prognosis.

The study led to the following findings:

• The study included 289 geriatric patients with hip fractures (median age 82) and 45 age-matched healthy individuals.
• Severe infections were reported in 8% of the patients.
• The 30-day mortality rate among patients was 9%.
• Patients showed a full range of neutrophil inflammation categories (0–6), whereas healthy controls showed only categories 0, 1, and 3.
• A newly identified neutrophil category was associated with higher leukocyte counts, and elevated C-reactive protein (CRP) levels, and a trend toward more infections and higher mortality.
• Among patients receiving palliative care, 30-day mortality was 50% in the low-inflammation group (categories 0–1) and 83% in those with higher inflammation levels.

In conclusion, the researchers highlight that “neutrophil profiling offers a practical and effective method to assess systemic inflammation in elderly patients with hip fractures.” According to their findings, “the identification of neutrophil categories may help guide shared decision-making, especially in determining the suitability of patients for surgery or palliative care.” They further noted that “patients falling into categories 0–1 appear more likely to be fit for surgery when no other major risk factors are present.”

However, the researchers emphasize that “further studies are needed to assess the long-term quality of life in patients who survive beyond 30 days” and suggest that “ongoing immune monitoring throughout hospitalization and treatment could provide deeper insights.” They believe that “a better understanding of these immune patterns is key to improving care and optimizing outcomes for geriatric trauma patients.”

Reference:

de Fraiture, E.J., Nijdam, T.M.P., van Eerten, F.J.C. et al. Exploring the role of systemic inflammation in guiding clinical decision making for geriatric patients with a hip fracture. Eur J Trauma Emerg Surg 51, 192 (2025). https://doi.org/10.1007/s00068-025-02875-x