Prognostic Value of HALP Score, PNI, and SII in Predicting 1-Year Mortality in Geriatric Femoral Fractures: A 5-Year Emergency Department Cohort Study

BACKGROUND With the global rise in geriatric populations, femoral fractures in elderly individuals have become a major health burden. This study aimed to evaluate the prognostic value of 3 readily available laboratory-based indices - HALP (hemoglobin, albumin, lymphocyte, platelet), Prognostic Nutritional Index (PNI), and Systemic Immune-Inflammation Index (SII) - in predicting 1-year mortality among elderly patients with femoral fractures. MATERIAL AND METHODS This retrospective cohort study included 309 patients aged ≥65 years who presented to the emergency department of a tertiary university hospital between 2018 and 2023 with low-energy femoral fractures and who underwent surgery. Demographic, clinical, and laboratory data were collected. HALP, PNI, and SII were calculated preoperatively. In-hospital, 30-day, and 1-year mortality were recorded. ROC analysis was used to assess the predictive accuracy of each index. RESULTS One-year mortality was 32.4%, while in-hospital and 30-day mortality were 5.5% and 11%, respectively. Lower albumin and PNI scores were significantly associated with higher mortality at all time points (P<0.001). PNI demonstrated moderate predictive accuracy (AUC=0.659), while HALP had limited but statistically significant predictive value (AUC=0.577, P=0.030). SII did not show statistically significant prognostic value (AUC=0.549, P=0.166). Multivariate analysis showed PNI and HALP are independent predictors of long-term mortality. CONCLUSIONS PNI and HALP are practical, cost-effective tools with prognostic utility in elderly patients with femoral fractures. Early identification of high-risk individuals using these biomarkers may facilitate targeted interventions and improved outcomes. Future multicenter prospective studies are warranted for external validation.