A Retrospective Analysis of the Link Between the Prognostic Nutritional Index and 1-Year Mortality Rates in Older Adults Suffering From Femoral Neck Fractures

Why It Matters

Integrating PNI into pre‑operative assessment can flag nutritionally vulnerable patients, enabling targeted interventions that may improve survival after hip fracture surgery.

Key Takeaways

• Lower pre‑operative PNI linked to higher 1‑year mortality
• Each unit increase in PNI reduces mortality odds by 6%
• Optimal PNI cutoff identified at 43.68 (71% sensitivity)
• PNI AUC of 0.68 indicates moderate predictive ability
• Simple blood tests make PNI feasible for routine pre‑op assessment

Pulse Analysis

Hip fractures, particularly femoral neck fractures, remain a leading cause of morbidity and mortality among older adults. As the global population ages, the incidence of these injuries is projected to rise sharply, placing a heavier burden on healthcare systems. While surgical repair is essential, postoperative outcomes vary widely, driven by factors such as age, comorbidities, and, increasingly recognized, nutritional status. Malnutrition often goes unnoticed in frail patients, yet it amplifies the inflammatory response to surgery, accelerates muscle loss, and predisposes individuals to complications that can culminate in death within the first year after injury.

The Prognostic Nutritional Index (PNI) offers a pragmatic solution by combining serum albumin and lymphocyte counts—two routine laboratory values—into a single metric that reflects both protein reserves and immune competence. In the recent Chinese cohort, a mean PNI of 45.66 distinguished survivors from non‑survivors, and multivariable analysis confirmed its independent protective effect. Although the area under the ROC curve of 0.68 signals only moderate discrimination, the identified threshold of 43.68 provides clinicians with a concrete benchmark: patients below this level face a substantially higher mortality risk and may benefit from pre‑emptive nutritional support, immunomodulatory strategies, or more intensive postoperative monitoring.

For health systems aiming to reduce hip‑fracture mortality, incorporating PNI into existing risk‑assessment tools could enhance decision‑making without adding significant cost or complexity. Future prospective, multicenter studies should explore how PNI interacts with frailty scores, surgical timing, and rehabilitation protocols, and whether correcting low PNI pre‑operatively translates into measurable survival gains. As evidence accumulates, PNI may evolve from a modest predictor to a cornerstone of personalized peri‑operative care for the growing elderly population.