A novel approach for identifying serological markers indicative of surgical-site infection following spine surgery: Postoperative lymphopenia is a risk factor
A novel approach for identifying serological markers indicative of surgical-site infection following spine surgery: Postoperative lymphopenia is a risk factor
复制标题
DOI：
10.1016/j.jos.2021.03.003
复制
发表时间：
2022-05-16
影响因子：
1.7
通讯作者：
Chiba, Kazuhiro
中科院分区：
文献类型：
--
作者：
Imabayashi, Hideaki;Miyake, Atsushi;Chiba, Kazuhiro
背景：据报道，脊柱手术后淋巴细胞减少症（PL）是手术部位感染（SSI）的一个指标。经常遇到没有SSI的PL，导致治疗困境。我们将重点放在PL上，以提高检测SSI的准确性。方法：共有329例患者接受了脊柱手术，其中9例患者出现SSI。在术前和术后第2、7和14天测量全血细胞计数、分类计数和C反应蛋白（CRP）水平。评价PL和SSI之间的关系，并比较所有病例的PL和非PL条件。然后，我们将患者分为两组：PL和非PL，并确定有用的血清学标志物使用接收器工作特征curved.Results：61例患者提出PL，包括4个SSI。然而，PL并不直接被认为是SSI的生物标志物（p = 0.067）。我们发现PL是SSI的风险因素（p = 0.004，比值比：7.54）。在所有病例中，淋巴细胞计数和CRP水平在PL组和非PL组之间在所有围手术期时间点均存在显著差异。PL组中SSI和非SSI病例术后第7天的白色血细胞计数、中性粒细胞计数和CRP水平存在显著差异。CRP的曲线下面积（AUC）大于其他参数。中性粒细胞计数仅在非PL组中作为标记物有效。两个临界值（CRP：3.7 mg/dL（PL组）和中性粒细胞计数：6172/mL（非PL组））的组合具有较高的特异性（87.2%）和敏感性（88.9%），而只有一个临界值（CRP：2.9 mg/dL）的特异性为77.4%，敏感性为77.8%。结论：大约五分之一的患者术后发生PL，这是SSI的风险因素，伴有持续的高炎症。以PL为基础的诊断和建立诊断临界值比仅为所有病例建立一个临界值更合适。(c)2021年由Elsevier B. V.代表日本骨科协会出版。
Background: Postoperative lymphopenia (PL) after spine surgery is reported to be an indicator of surgical-site infection (SSI). PL without SSI is often encountered, resulting in a treatment dilemma. We focused on PL, so as to improve the accuracy of detecting SSI. Methods: In total, 329 patients underwent spine surgery, including nine patients presenting with SSI. The complete blood cell counts, differential counts, and C-reactive protein (CRP) level were measured pre-surgery and on postoperative days 2, 7, and 14. The relationships between PL and SSI were evaluated, and PL and non-PL conditions were compared among all cases. We then divided the patients into two groups: PL and non-PL, and determined the useful serological markers using receiver operating characteristic curves.Results: Sixty-one patients presented with PL, including four with SSI. However, PL was not directly suggested as a biomarker of SSI (p = 0.067). We revealed PL as a risk factor for SSI (p = 0.004, Odds ratio: 7.54). Among all cases, the lymphocyte count and CRP level differed significantly between the PL and non-PL groups at all perioperative time-points. The white blood cell count, neutrophil count, and CRP levels on postoperative day 7 significantly differed between the SSI and non-SSI cases in the PL group. The area under the curve (AUC) for CRP was greater than that of the other parameters. The neutrophil count was only effective as a marker in the non-PL group. The combination of two cutoff values (CRP: 3.7 mg/dL (PL group) and neutrophil count: 6172/mL (non-PL group)) presented high specificity (87.2%) and sensitivity (88.9%), while only one cutoff value (CRP: 2.9 mg/dL) had a specificity of 77.4% and sensitivity of 77.8%. Conclusions: Approximately one-fifth of patients developed PL post-surgery, which was a risk factor for SSI, with constant high inflammation. Grouping based on PL and establishing diagnostic cutoff values are more appropriate than establishing only one cutoff value for overall cases.(c) 2021 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.