{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T04:54:25Z","timestamp":1776401665110,"version":"3.51.2"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hip fractures in super-elderly patients are associated with high short-term mortality. The Prognostic Nutritional Index (PNI) is a simple marker reflecting both nutritional and immune status, but its prognostic value in super-elderly hip fracture patients remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively included 614 patients aged \u226580\u202fyears with traumatic hip fractures from a tertiary hospital (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f457) and the MIMIC-IV database (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f157). PNI was calculated from serum albumin and absolute lymphocyte count measured within 24\u202fh of admission. The optimal PNI cut-off for predicting 90-day all-cause mortality was determined using X-tile and used to define low- and high-PNI groups. Least absolute shrinkage and selection operator (LASSO) regression, Cox proportional hazards models, and propensity score matching (PSM) were applied to evaluate the association between admission PNI and 90-day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The optimal PNI cut-off was 37.2, yielding 231 patients (37.6%) in the low-PNI group (PNI\u202f\u2264\u202f37.2) and 383 (62.4%) in the high-PNI group (PNI\u202f&amp;gt;\u202f37.2). Before PSM, patients with low PNI were older and had worse laboratory profiles, including lower hemoglobin, albumin, and lymphocyte counts. The 90-day mortality rate was significantly higher in the low-PNI than in the high-PNI group (21.65% vs. 9.40%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). LASSO identified sex, race, chronic pulmonary disease, hemoglobin, creatinine, and PNI as variables associated with 90-day mortality. After 1:2 PSM, 398 patients were retained with most baseline imbalances effectively reduced. In robust Cox proportional hazards analyses for the matched cohort, high PNI was associated with lower 90-day mortality in univariate models (HR 0.34, 95% CI 0.18\u20130.63;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001); Race violated the proportional hazards assumption; this association remained robust in the fully adjusted robust Cox model with race treated as a stratified variable (HR 0.34, 95% CI 0.19\u20130.63;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A low admission PNI (\u226437.2) is strongly and independently associated with higher 90-day mortality in super-elderly patients with hip fractures. PNI, derived from routine laboratory tests within 24\u202fh of admission, provides a simple and inexpensive tool for early risk stratification in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1788594","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T04:12:37Z","timestamp":1776399157000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic nutritional index at admission predicts 90-day mortality in patients aged \u226580\u202fyears with hip fracture: a system-level readout of the nutrition\u2013immune milieu relevant to microenvironment-responsive bone repair"],"prefix":"10.3389","volume":"13","author":[{"given":"Delong","family":"Yin","sequence":"first","affiliation":[{"name":"Center of Orthopedics and Sports Medicine, Heyou Hospital","place":["Foshan City, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, ShiPai Hospital of Dongguan","place":["Dongguan, Guangdong, China"]},{"name":"Department of Orthopedics, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyue","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenbo","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]},{"name":"Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Shenzhen Nanshan People\u2019s Hospital","place":["Shenzhen, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoqing","family":"Jin","sequence":"additional","affiliation":[{"name":"Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, China"]},{"name":"Department of Critical Care Medicine, The Third Affiliated Hospital, Guangzhou Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.1056\/NEJMra2412275","article-title":"Malnutrition in older adults","volume":"392","author":"Cruz-Jentoft","year":"2025","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1080\/03007995.2024.2380007","article-title":"Nutritional care in older adults: are we doing everything? 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