ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1543671
This article is part of the Research TopicInnovations and Strategies for Comprehensive Frailty Management in Older PeopleView all 8 articles
Systemic Immune Inflammation Index (SII) and System Inflammation Response Index (SIRI) predict frailty progression in older patients undergoing elective orthopedic surgery
Provisionally accepted
- 1Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing Municipality, China
- 2Beijing Hospital, Beijing, Beijing, China
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Introduction: The frailty status of older patients undergoing elective orthopedic surgery significantly influences their surgical benefits. Evaluating the progression of postoperative frailty assists clinicians in making informed clinical decisions. The biomarkers SII and SIRI, which reflect chronic inflammation and immune status, may play a positive role in predicting the progression of frailty.Methods: We conducted a single-center prospective cohort study, including patients aged 65 and older who underwent elective orthopedic surgery for chronic degenerative conditions between January 2020 and January 2022. Basic patient information, laboratory results, and frailty assessments were collected. LASSO regression was used to identify important predictive variables, and multivariate logistic regression was employed to assess the associations between SII/SIRI and frailty progression. Restricted cubic splines (RCS) were used to detect potential nonlinear relationships between them. ROC curves and AUC values were utilized to assess their predictive performance. Finally, we presented stratified analyses and interaction tests of covariates.Results: A total of 546 patients were included, with 109 (19.5%) experiencing postoperative frailty progression. Multivariate regression analysis revealed that ln.SII and ln.SIRI were positively correlated with frailty progression in the fully adjusted model, with odds ratios (OR) of 3.449 and 3.084, respectively. These findings were consistent across various subgroups. The linear trend between SII-SIRI pattern/SII/SIRI levels and frailty progression were statistically significant. However, the RCS curve indicated that the nonlinear model significantly outperformed the linear model. The AUC values for ln.SII, ln.SIRI and the combined model were 0.686, 0.710 and 0.723, respectively. The cutoff values for ln.SII and ln.SIRI were 5.93 and 0.10, respectively. Conclusion: SII and SIRI can effectively serve as effective non-invasive preoperative screening tools for identifying older patients with chronic degenerative orthopedic diseases who are at high risk of frailty progression following elective surgical procedures.
Keywords: older, Frailty, SII, SIRI, Orthopedic
Received: 09 Jan 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Gao, Zheng, Wang, Zhang, Shi, Wang, Wang and Xue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qingyun Xue, Beijing Hospital, Beijing, 100730, Beijing, China
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