Predictive value of shock indices in 30-day mortality for elderly hip fracture patients: a retrospective cohort study

Objective: To determine the predictive value of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) for 30-day mortality in elderly patients with hip fractures and to compare these indices with established measures such as the American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).

Methods: This retrospective cohort study was conducted at a single-center, tertiary care hospital. The study included 2771 patients aged 65 and older who presented with hip fractures between January 1, 2014, and December 31, 2022. The primary outcome measure was 30-day mortality, while the secondary analysis focused on 1-year mortality. Comparisons were made between SI, MSI, ASI, ASA score, CCI, NLR, and PLR using receiver operating characteristic curve analyses to determine their predictive value for mortality.

Results: The mean age was 80.85 ± 7.48, with 63% being female (n = 1747). Modified Shock Index demonstrated the highest predictive performance for 30-day outcomes with a sensitivity of over 70%, a specificity of over 80%, and an area under the curve (AUC) value above 0.8, outperforming the other indices. Neutrophil-to-lymphocyte ratio was also significantly associated with mortality (AUC = 0.779), with a cutoff value of 5.76. For 1-year mortality, MSI showed superior performance (AUC = 0.669-0.673), although the sensitivity and specificity were lower than for 30-day mortality.

Conclusion: Modified Shock Index can aid in identifying high-risk elderly hip fracture patients for short-term mortality and contribute to preoperative planning. Integrating MSI with traditional scoring systems like ASA and CCI may enhance early intervention strategies. Future studies should validate the use of MSI across different populations and orthopedic conditions.

Cite this article as: İğde N, Keskin A, Başkaya N, Yuvacı F. Predictive value of shock indices in 30-day mortality for elderly hip fracture patients: a retrospective cohort study. Acta Orthop Traumatol Turc., 2026, 60 (1), 0225, doi: 10.5252/j.aott.2026.25225.