Prognostic Role of Blood Inflammatory Composite Biomarkers in Dvt After Lower Extremity Fractures

Sanam Mohammadzadeh; Farzad Fayedeh; Shokufe Khanzade; Philip Chen; Richard K Shields

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Prognostic Role of Blood Inflammatory Composite Biomarkers in Dvt After Lower Extremity Fractures

Journal article

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Prognostic Role of Blood Inflammatory Composite Biomarkers in Dvt After Lower Extremity Fractures

Sanam Mohammadzadeh, Farzad Fayedeh, Shokufe Khanzade, Philip Chen and Richard K Shields

The Iowa orthopaedic journal, Vol.46(1), pp.293-301

2026

PMCID: PMC13525540

PMID: 42668964

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https://pmc.ncbi.nlm.nih.gov/articles/PMC13525540/View

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Abstract

This study aimed to comprehensively assess the most recent data on the prognostic effects of hematologic markers, including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII), on deep vein thrombosis (DVT) following lower limb fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study was registered in PROSPERO (CRD420251006336). We performed a comprehensive search in the PubMed, EMBASE, Web of Science, and Scopus electronic databases. Date of publication and language were not restricted. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated and all statistical analyses were performed using Stata 18 software. Ten studies, involving a total of 6183 patients with lower extremity fractures, of whom 896 developed DVT, were included in the final analysis. The results indicated that, compared to the non-DVT group, patients with DVT had higher levels of NLR (SMD = 0.48, 95% CI = 0.02-0.94, p = 0.04) and SII (SMD = 1.01, 95% CI = 0.121.89, p = 0.02). However, PLR and MLR level was not different between the two groups. Among the evaluated biomarkers, SII demonstrated the highest specificity (80%, PLR = 74%), while NLR had the highest sensitivity (68%). The literature supported that, compared to the non-DVT group, patients with DVT had higher levels of NLR and SII. Among these biomarkers, SII demonstrated the highest specificity, while NLR had the highest sensitivity. Composite inflammatory markers, particularly SII, may hold value in DVT risk stratification during post-fracture period. II.

Biomarkers - blood

Fractures, Bone - blood

Fractures, Bone - complications

Humans

Inflammation - blood

Lower Extremity - injuries

Neutrophils

Prognosis

Venous Thrombosis - blood

Venous Thrombosis - etiology

Details

Title: Subtitle: Prognostic Role of Blood Inflammatory Composite Biomarkers in Dvt After Lower Extremity Fractures
Creators: Sanam Mohammadzadeh - Tabriz University of Medical Sciences
Farzad Fayedeh - Birjand University of Medical Sciences
Shokufe Khanzade - University of Iowa
Philip Chen - University of Iowa, Orthopedics and Rehabilitation
Richard K Shields - University of Iowa
Resource Type: Journal article
Publication Details: The Iowa orthopaedic journal, Vol.46(1), pp.293-301
PMID: 42668964
PMCID: PMC13525540
NLM abbreviation: Iowa Orthop J
ISSN: 1555-1377
eISSN: 1555-1377
Language: English
Date published: 2026
Academic Unit: Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
Record Identifier: 9985222684202771

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