Assessing D-Dimer-to-Albumin Ratio for Predicting Preoperative DVT

### Assessing D-Dimer-to-Albumin Ratio for Predicting Preoperative DVT in Older Patients with Hip Fractures

**Abstract**: In older patients with hip fractures, the prediction of preoperative deep vein thrombosis (DVT) is critical for improving surgical outcomes. This study evaluates the combined use of the D-Dimer-to-Albumin Ratio (DAR) and the Neutrophil-to-Lymphocyte Ratio (NLR) as predictive indicators for preoperative DVT in this vulnerable population.

**Introduction**: Hip fractures pose significant health risks, especially among the elderly, with projections indicating an increase in cases to approximately six million by 2050 (Viamont-Guerra et al., 2024). The incidence of preoperative DVT in older patients with hip fractures reaches alarming rates, estimated between 20% and 30% (Fan et al., 2021). Identifying those at risk is essential for implementing effective preventive measures.

**Methods**: This cross-sectional study analyzed data from 1,177 patients aged 65 and older with hip fractures who were admitted to Changhai Hospital from January 2018 to December 2023. Demographic data, comorbidities, medication history, and preoperative laboratory results were collected. Binary logistic regression and Receiver Operating Characteristic (ROC) curve analyses were utilized to determine associations and predictive values of DAR and NLR for preoperative DVT.

**Results**: Among the participants, 23 patients (2%) developed lower extremity DVT prior to surgery. Notably, the multivariate logistic regression analysis highlighted that advanced age (OR = 1.08, 95% CI = 1.01-1.15, P = 0.015), higher DAR (OR = 1.53, 95% CI = 1.21-1.92, P < 0.001), and elevated NLR (OR = 1.24, 95% CI = 1.10-1.39, P < 0.001) were significantly associated with DVT risk. The ROC analysis demonstrated that the combined use of DAR and NLR yielded an area under the curve (AUC) of 78.72% (95% CI = 68.24-89.20%), indicating superior predictive power compared to either marker alone.

**Discussion**: The findings suggest that the DAR and NLR can serve as effective biomarkers for predicting preoperative DVT among older patients with hip fractures. The lower incidence of DVT observed in this study (2%) compared to previous reports may be attributed to timely hospitalization within 72 hours post-injury (Cho et al., 2015). The implications of this study advocate for the integration of DAR and NLR into clinical practice to enhance risk stratification and facilitate timely interventions.

**Conclusion**: In summary, the D-Dimer-to-Albumin Ratio and Neutrophil-to-Lymphocyte Ratio are promising predictive indicators for preoperative DVT among older patients with hip fractures. Future multicenter studies are warranted to validate these findings and explore the clinical utility of these biomarkers in broader populations.

**Ethics Statement**: The study was approved by the Ethics Committee of Changhai Hospital (CHEC2024-257), adhering to the principles of the Declaration of Helsinki.

**Acknowledgments**: The authors express gratitude to all participants and contributors involved in this research. The study was funded by the National Natural Science Foundation of China (grant number 82272205).

**References**: 1. Viamont-Guerra MR, et al. (2024). Ultra-early versus early surgery for Hip fracture. Cochrane Database Syst Rev. 6:Cd015697. 2. Fan J, et al. (2021). Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study. BMC Musculoskeletal Disorders. 22(1):328. 3. Cho YH, et al. (2015). Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthopedic Surg. 7(3):298-302.