Lymphocyte Count at 4 Days Postoperatively and CRP Level at 7 Days Postoperatively
Lymphocyte Count at 4 Days Postoperatively and CRP Level at 7 Days Postoperatively
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DOI：
10.1097/brs.0000000000001501
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发表时间：
2016-07-15
期刊：
影响因子：
3
通讯作者：
Tanaka, Yasuhito
中科院分区：
文献类型：
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作者：
Iwata, Eiichiro;Shigematsu, Hideki;Tanaka, Yasuhito
研究设计。一项病例对照研究。本研究的目的是确定不受手术环境影响的后路内固定脊柱融合术中手术部位感染（SSI）的生化标志物，并确定这些标志物的诊断截止点。背景资料摘要。许多生化标志物可用于SSI的早期检测；然而，这些指标可能受到手术因素的影响。我们回顾了固定脊柱融合术前、术后1、4和7天的c反应蛋白水平、总白细胞计数和差异计数数据。我们将141例患者分为SSI组（发生深度SSI的患者）和无SSI组。我们确定了组间哪些标记物有显著差异，并确定了无ssi组中不受手术环境（手术时间、术中出血量、融合节段数量）影响的标记物。然后，我们通过使用受体操作特征曲线确定这些未受影响标记的诊断截止点。选择3个指标：术后4 d淋巴细胞计数（临界值1180/mL，敏感性90.9%，特异性65.4%，曲线下面积[AUC] 0.80），术后7 d淋巴细胞计数（临界值4.4 mg/dL，敏感性90.9%，特异性89.2%,AUC 0.95）。术后4天和7天的淋巴细胞计数和术后7天的c反应蛋白水平是固定脊柱融合术后SSI的可靠标志。4天的淋巴细胞计数对筛查是有用的，因为它灵敏度高，而且可以早期测量。7天的c反应蛋白水平对于明确诊断是有用的，因为它的高敏感性和特异性以及大AUC。
Study Design. A case-control study.Objective. The objective of this study is to identify biochemical markers for surgical site infection (SSI) in posterior instrumented spinal fusion that are not affected by operative circumstances and to determine diagnostic cutoffs for these markers.Summary of Background Data. Numerous biochemical markers may be used for early detection of SSI; however, these markers may be affected by operative factors.Methods. We reviewed data on C-reactive protein level and total white blood cell count and differential count before instrumented spinal fusion and at 1, 4, and 7 days postoperatively. The 141 patients in our sample were divided into an SSI group (patients who developed deep SSI) and a no-SSI group. We determined which markers differed significantly between groups and identified those not affected by operative circumstances (operating time, intraoperative blood loss, number of fusion segments) in the no-SSI group. Then, we determined diagnostic cutoffs for these unaffected markers by using receiver-operating characteristic curves.Results. Three markers were selected: lymphocyte count at 4 days postoperatively (cutoff 1180/mL, sensitivity 90.9%, specificity 65.4%, area under the curve [AUC] 0.80), lymphocyte count of at 7 days postoperatively (cutoff 4.4 mg/dL, sensitivity 90.9%, specificity 89.2%, AUC 0.95).Conclusion. Lymphocyte count at 4 and 7 days postoperatively and C-reactive protein level at 7 days postoperatively are reliable markers for SSI following instrumented spinal fusion. Lymphocyte count at 4 days should be useful for screening because of its high sensitivity and because it can be measured early. C-reactive protein level at 7 days should be useful for definitive diagnosis given its high sensitivity and specificity and large AUC.