Preoperative neutrophil-to-lymphocyte ratio and refracture risk in hip fracture patients: a propensity score-matched analysis

Background The relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and refracture risk in hip fracture patients remains unclear.Methods This retrospective study included 701 patients with hip fractures between 2018 and 2020. Multivariate logistic regression and propensity score matching (PSM) assessed the association between preoperative NLR (analysed as a continuous variable) and refracture risk, adjusting for age, sex, comorbidities, fracture characteristics and laboratory parameters. Subgroup and dose-response analyses evaluated robustness.Results Refracture occurred in 119 patients (16.98%). Each unit increase in NLR (as a continuous variable) was associated with 8.0% increased refracture odds (odds ratio (OR) = 1.080, 95% confidence interval (CI) = 1.019–1.144, p = 0.009). PSM confirmed this association (crude OR = 1.119, p = 0.006; adjusted OR = 1.108, p = 0.014). The association remained consistent across patient subgroups (all p for interaction > 0.05) with a linear dose–response relationship.Conclusions Elevated preoperative NLR independently predicts refracture risk in hip fracture patients. This readily available biomarker may facilitate risk stratification and guide prevention strategies.