Preoperative neutrophil-to-lymphocyte ratio and postoperative deep vein thrombosis after tibial plateau fracture: a retrospective analysis of a prospectively collected cohort

BACKGROUND: Deep vein thrombosis (DVT) is a common and serious postoperative complication of tibial plateau fracture that significantly impacts patient prognosis, but its accurate risk prediction remains challenging. The utility of neutrophil-to-lymphocyte ratio (NLR) as a simple marker of inflammatory-immune status in thrombosis risk assessment is not clear, especially in the tibial plateau fracture population. METHODS: The study enrolled 1582 adult patients with tibial plateau fracture who underwent surgery from October 2019 to December 2023. Demographic characteristics, medical co-morbidities, surgical factors, and laboratory indicators were collected, with DVT within 14 days of surgery as the primary outcome. LASSO regression was used to screen key variables, and the dose-effect relationship between NLR and DVT was analyzed by 4-node restricted cubic spline (RCS) and the optimal cut-off value was determined, combined with multivariable logistic regression to assess the strength of the association, and sensitivity analyses to verify the robustness of the results. RESULTS: Baseline data showed that 54.4% were male with a mean age of 48.2 ± 12.5 years. Postoperative DVT occurred in 548 patients (34.64%). LASSO regression screened 16 variables suitable for inclusion in the model for adjustment. RCS revealed a significant nonlinear association (P < 0.001), and the optimal cut-off value was determined to be 3.265. After PSM, high NLR remained an independent risk factor for DVT. Sensitivity analyses confirmed robustness. CONCLUSION: NLR > 3.265 independently predicts tibial plateau fracture postoperative DVT. Integrating NLR into risk models may aid personalized antithrombotic strategies, improving patient prognosis.