Emerging evidence suggests that inflammatory and immune biomarkers may serve as prognostic indicators across diverse clinical contexts. This study sought to investigate the association between the high-sensitivity C-reactive protein to lymphocyte ratio (hs-CLR) and the risk of postoperative delirium in elderly patients undergoing surgery for hip fractures. We conducted a retrospective cohort study of patients aged 60 years or older who underwent surgical management for hip fractures at a university-affiliated tertiary hospital between January 2021 and December 2024. The primary exposure was hs-CLR, and the primary endpoint was 30-day postoperative delirium, ascertained through systematic review of inpatient medical records and confirmed by outpatient and telephone follow-up. The relationship between hs-CLR and delirium was explored using restricted cubic spline modeling, receiver operating characteristic curve analysis, univariate comparisons, and multivariate logistic regression. A total of 582 patients (192 males, 390 females; mean age 73.8 ± 8.4 years) were included. The 30-day incidence of delirium was 21.3% (124/582). Both unadjusted and adjusted restricted cubic spline analyses revealed a significant nonlinear dose-response association between hs-CLR and delirium risk ( P <.05). Using a clinically determined threshold of 36.0, patients were stratified into low and high hs-CLR groups. Patients with elevated hs-CLR were more often male, had a higher comorbidity burden (reflected by higher age-adjusted Charlson comorbidity index and American Society of Anesthesiologists class) and poorer nutritional and general health status (lower serum albumin, red blood cell count, and serum sodium) than those with low hs-CLR. Multivariable logistic regression demonstrated that hs-CLR ≥36.0 was independently associated with increased odds of postoperative delirium (fully adjusted model: odds ratio 2.35, 95% CI 1.47–3.74; backward elimination model: odds ratio 2.28, 95% CI 1.46–3.54). This study delineates a robust nonlinear association between elevated hs-CLR and the risk of postoperative delirium in elderly hip fracture patients, and establishes that hs-CLR ≥36.0 is independently associated with delirium. These findings underscore the potential value of incorporating hs-CLR into preoperative risk stratification to enhance perioperative management in this vulnerable population.
Liu et al. (Fri,) studied this question.