Relationship between preoperative serum rapid turnover proteins and early-stage surgical wound infection after spine surgery
Relationship between preoperative serum rapid turnover proteins and early-stage surgical wound infection after spine surgery
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DOI：
10.1007/s00586-016-4855-z
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发表时间：
2017-12-01
影响因子：
2.8
通讯作者：
Shimada, Yoichi
中科院分区：
文献类型：
--
作者：
Kudo, Daisuke;Miyakoshi, Naohisa;Shimada, Yoichi
营养不良是术后并发症的重要危险因素之一。转铁蛋白、前白蛋白和视黄醇结合蛋白，即所谓的快速周转蛋白（RTPs），可能是早期检测营养缺乏的较好指标。然而，很少有研究描述了血清RTP水平对脊柱手术术后手术部位感染（SSI）的影响。本研究的目的是探讨术前血清RTPs与术后SSI的关系，回顾性分析了2014年至2015年在同一机构接受脊柱手术的105例患者（男性64例，女性41例;平均年龄64.4岁;年龄范围20-88岁）的数据。评估术前总淋巴细胞计数、血清白蛋白、转铁蛋白、前白蛋白、视黄醇结合蛋白、术前和术后C反应蛋白（CRP）、白色血细胞计数（WBC）和总淋巴细胞计数。术后CRP、WBC和总淋巴细胞计数每周重复两次或三次，直至出院。每例患者均给予广谱青霉素或第二代头孢菌素作为预防性抗生素。当术后第3或4天观察到CRP反复升高或淋巴细胞减少（不超过10%或1000/μ L）时，诊断为可能的SSI。使用Mann-Whitney U或卡方检验比较可能SSI组和非SSI组之间的变量。将单因素分析中的所有变量纳入多因素logistic回归分析，以确定可能的术后SSI的危险因素。可能SSI组的平均手术时间显著长于非SSI组（p = 0.036），术前总淋巴细胞计数和血清前白蛋白水平显著低于非SSI组（分别为p = 0.002，p = 0.048）。单变量分析，手术时间（p = 0.012），术前总淋巴细胞计数（p = 0.041），血清白蛋白水平（p = 0.038），血清前白蛋白水平（p = 0.044）是可能发生SSI的重要因素，多元logistic回归分析显示，手术时间是可能发生SSI的重要因素（比值比1.008，95%置信区间（CI）1.001-1.015，p = 0.024）。低前白蛋白水平是脊柱手术中早期SSI的可能风险因素，尽管无统计学意义;手术时间是多变量分析中SSI的最重要指标。
Malnutrition is one of the important risk factors for postoperative complications. Transferrin, prealbumin, and retinol-binding protein, so-called rapid turnover proteins (RTPs), may be the better indicators for early detection of nutritional deficits. However, few studies have described the impact of serum RTP levels on postoperative surgical site infection (SSI) in spine surgery. The purpose of this study was to investigate the relationship between preoperative serum RTPs and postoperative SSI.The data of 105 patients (64 male, 41 female; average age 64.4 years; age range 20-88 years) who underwent spine surgery in a single institution between 2014 and 2015 were retrospectively analyzed. Preoperative total lymphocyte count, serum albumin, transferrin, prealbumin, retinol-binding protein, pre-and postopeartive C-reactive protein (CRP), white blood cell count (WBC), and total lymphocyte count were evaluated. Postoperative CRP, WBC, and total lymphocyte count were repeated two or three times/week until hospital discharge. A broad spectrum penicillin or second generation cephalosporin was administered as a prophylactic antibiotic to each patient. When repeated CRP elevation or lymphopenia (no more than 10% or 1000/mu L) after postoperative day 3 or 4 was observed, possible SSI was diagnosed. Variables between possible SSI group and non-SSI group were compared using Mann-Whitney U or Chi square test. All variables on univariate analysis were included in multiple logistic regression analysis to identify risk factors for possible postoperative SSI.Thirty-five patients were diagnosed with possible SSI. The mean operative time of possible SSI group was significantly longer (p = 0.036), preoperative total lymphocyte count and serum prealbumin level of possible SSI group were significantly lower (p = 0.002, p = 0.048, respectively) than that of non-SSI group. On univariate analysis, operative time (p = 0.012), preoperative total lymphocyte count (p = 0.041), serum albumin level (p = 0.038), and serum prealbumin level (p = 0.044) were significant contributors to possible SSI, and multiple logistic regression analysis revealed that operative time was the significant contributor to possible SSI (odds ratio 1.008, 95% confidence interval (CI) 1.001-1.015, p = 0.024).A low prealbumin level is a possible risk factor for early-stage SSI in spine surgery, though it was not statistically significant; operative time was the most important indicator of SSI on multivariate analysis.