PDF(Pubmed)
Abstract：
OBJECTIVE: To identify which non-invasive infection indicators could better predict post-cervical cerclage (CC) infections, and on which days after CC infection indicators should be closely monitored.
METHODS: The retrospective, single-center study included 619 single-pregnancy patients from January 2021 to December 2022. Patients were categorized into infected and uninfected groups based on physicians\' judgments of post-CC infections. Registered information included patient characteristics, cervical insufficiency history, gestational age at CC, surgical method (McDonald/Shirodkar), purpose of CC, mid-pregnancy miscarriage/preterm birth, infection history or risk factors, and infection indices on days 1, 3, 5, and 7 after CC. Propensity score matching (PSM) was applied to reduce patient characteristic bias. Statistical analysis of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), percentage of neutrophil count (NEU_P), interleukin-6 (IL-6), and procalcitonin (PCT) in the infected group compared with the uninfected group was performed using chi-square tests and t-tests. Receiver operating characteristic (ROC) curves were used to further assess the diagnostic value of CRP, PCT, and CRP-PCT in combination.
RESULTS: Among the 619 included patients, 206 patients were matched using PSM and subsequently assessed. PCT values on day 1 and day 3 after CC exhibited significant differences between the two groups in two statistical ways (P < 0.01, P < 0.05). The CRP levels on day 1 were significantly higher in the infected group compared to the uninfected group in two statistical ways (P < 0.05). On day 3, the mean CRP value was significantly elevated in the infected group compared to the uninfected group (P < 0.05). Analyses of IL-6, WBC, NEU, and NEU_P did not yield clinically significant results. The area under the ROC curves for CRP, PCT, and CRP-PCT on day 1 and day 3 were all below 0.7. In the preventive CC group, the AUC values of CRP and CRP-PCT obtained on d1 were found to be higher than 0.7, indicating moderate diagnostic accuracy.
CONCLUSIONS: For women after CC surgery, especially of preventive aim, increased serum CRP and PCT levels from post-CC day 1 to day 3 may signal a potential postoperative infection, warranting close monitoring.
METHODS: The retrospective, single-center study included 619 single-pregnancy patients from January 2021 to December 2022. Patients were categorized into infected and uninfected groups based on physicians\' judgments of post-CC infections. Registered information included patient characteristics, cervical insufficiency history, gestational age at CC, surgical method (McDonald/Shirodkar), purpose of CC, mid-pregnancy miscarriage/preterm birth, infection history or risk factors, and infection indices on days 1, 3, 5, and 7 after CC. Propensity score matching (PSM) was applied to reduce patient characteristic bias. Statistical analysis of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), percentage of neutrophil count (NEU_P), interleukin-6 (IL-6), and procalcitonin (PCT) in the infected group compared with the uninfected group was performed using chi-square tests and t-tests. Receiver operating characteristic (ROC) curves were used to further assess the diagnostic value of CRP, PCT, and CRP-PCT in combination.
RESULTS: Among the 619 included patients, 206 patients were matched using PSM and subsequently assessed. PCT values on day 1 and day 3 after CC exhibited significant differences between the two groups in two statistical ways (P < 0.01, P < 0.05). The CRP levels on day 1 were significantly higher in the infected group compared to the uninfected group in two statistical ways (P < 0.05). On day 3, the mean CRP value was significantly elevated in the infected group compared to the uninfected group (P < 0.05). Analyses of IL-6, WBC, NEU, and NEU_P did not yield clinically significant results. The area under the ROC curves for CRP, PCT, and CRP-PCT on day 1 and day 3 were all below 0.7. In the preventive CC group, the AUC values of CRP and CRP-PCT obtained on d1 were found to be higher than 0.7, indicating moderate diagnostic accuracy.
CONCLUSIONS: For women after CC surgery, especially of preventive aim, increased serum CRP and PCT levels from post-CC day 1 to day 3 may signal a potential postoperative infection, warranting close monitoring.
摘要：
目的：确定哪些非侵入性感染指标能更好地预测宫颈环扎术后感染。以及应密切监测CC感染指标后的天数。
方法：回顾性研究，单中心研究纳入了2021年1月至2022年12月的619例单胎妊娠患者.根据医生对CC后感染的判断，将患者分为感染组和未感染组。注册信息包括患者特征，宫颈机能不全病史,CC胎龄，手术方法（麦当劳/Shirodkar），CC的目的，妊娠中期流产/早产，感染史或危险因素，CC后第1、3、5和7天的感染指数。应用倾向评分匹配(PSM)来减少患者特征偏差。C反应蛋白(CRP)的统计学分析白细胞（WBC），中性粒细胞计数（NEU），中性粒细胞计数百分比(NEU_P)，白细胞介素-6（IL-6），和降钙素原（PCT）在感染组与未感染组相比，采用卡方检验和t检验。受试者工作特征(ROC)曲线用于进一步评估CRP的诊断价值,PCT,CRP-PCT联合应用。
结果：在纳入的619名患者中，206名患者使用PSM进行匹配并随后进行评估。CC后第1天和第3天的PCT值在两组间差异均有统计学意义(P<0.01,P<0.05)。感染组第1天的CRP水平明显高于未感染组（P<0.05）。第3天,与未感染组相比,感染组CRP平均值显著升高(P<0.05)。IL-6、WBC、NEU,和NEU_P没有产生临床显着结果。CRP的ROC曲线下面积,PCT,第1天和第3天的CRP-PCT均低于0.7。在预防性CC组中，在d1时获得的CRP和CRP-PCT的AUC值高于0.7,表明诊断准确性中等.
结论：对于CC手术后的女性，特别是预防目的，从CC后第1天到第3天，血清CRP和PCT水平升高可能预示着潜在的术后感染，保证密切监测。
方法：回顾性研究，单中心研究纳入了2021年1月至2022年12月的619例单胎妊娠患者.根据医生对CC后感染的判断，将患者分为感染组和未感染组。注册信息包括患者特征，宫颈机能不全病史,CC胎龄，手术方法（麦当劳/Shirodkar），CC的目的，妊娠中期流产/早产，感染史或危险因素，CC后第1、3、5和7天的感染指数。应用倾向评分匹配(PSM)来减少患者特征偏差。C反应蛋白(CRP)的统计学分析白细胞（WBC），中性粒细胞计数（NEU），中性粒细胞计数百分比(NEU_P)，白细胞介素-6（IL-6），和降钙素原（PCT）在感染组与未感染组相比，采用卡方检验和t检验。受试者工作特征(ROC)曲线用于进一步评估CRP的诊断价值,PCT,CRP-PCT联合应用。
结果：在纳入的619名患者中，206名患者使用PSM进行匹配并随后进行评估。CC后第1天和第3天的PCT值在两组间差异均有统计学意义(P<0.01,P<0.05)。感染组第1天的CRP水平明显高于未感染组（P<0.05）。第3天,与未感染组相比,感染组CRP平均值显著升高(P<0.05)。IL-6、WBC、NEU,和NEU_P没有产生临床显着结果。CRP的ROC曲线下面积,PCT,第1天和第3天的CRP-PCT均低于0.7。在预防性CC组中，在d1时获得的CRP和CRP-PCT的AUC值高于0.7,表明诊断准确性中等.
结论：对于CC手术后的女性，特别是预防目的，从CC后第1天到第3天，血清CRP和PCT水平升高可能预示着潜在的术后感染，保证密切监测。
