目的:手术部位感染(SSIs)的早期诊断可以预防手术翻修。炎症标记物(IM),如降钙素原(PCT),白细胞介素-6(IL-6),和肿瘤坏死因子α(TNF-α),在诊断SSI方面似乎比C反应蛋白(CRP)和白细胞(WBC)计数更准确。目的是比较CRP的预测值,白细胞计数,PCT,IL-6和TNF-α在SSI检测中的应用。
方法:从2019年至2024年,共有130名接受背部脊椎固定术的患者在最大护理脊柱中心进行了一项前瞻性诊断研究。术前和术后第1、2、3、5和7天(PODs)测量IMs。高度怀疑SSI的患者接受了翻修手术。当微生物学证据为阳性时诊断为SSI。将患者后验分为非感染组和感染组。
结果:118例患者的IMs(66.9±13.0年,61.0%的女性)被测量。118例患者中有15例(12.7%)发生了SSI。两组在现有高血压方面有所不同,仪表化段的数量,手术区域,CRPPOD1,7、PCTPOD7和IL-6POD3,5,7。包括这些参数的SSI检测的二元逻辑回归显示曲线下面积(AUC)为0.88(95%CI0.79-0.98;P<0.001)。IL-6POD7维持了SSI检测的主要效果(比值比=1.13;95%CI1.05-1.23;P=0.001),其本身的AUC为0.86(95%CI0.75-0.97)。
结论:与CRP相比,白细胞计数,PCT,和TNF-α,IL-6似乎是早期检测SSI的关键IM。
背景:drks。de:DRKS00033773,注册日期:29.02.2024,回顾性注册;脊柱手术炎症术后标志物(POMIS)试验。
OBJECTIVE: Early diagnosis of surgical site infections (SSIs) could prevent surgical revision. Inflammatory markers (IMs), such as procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), seem more accurate in diagnosing SSI than C-reactive protein (CRP) and white blood cell (WBC) count. The aim was to compare the predictive values of CRP, WBC count, PCT, IL-6, and TNF-α in SSI detection.
METHODS: A total of 130 patients undergoing dorsal spondylodesis from 2019 to 2024 were enrolled in a prospective diagnostic study at a maximum care spine center. IMs were measured preoperatively and on the postoperative days (PODs) 1, 2, 3, 5, and 7. Patients with high suspicion of SSI underwent revision surgery. SSI was diagnosed when the microbiological evidence was positive. Patients were divided a posteriori into the non-infection and infection groups.
RESULTS: IMs of 118 patients (66.9 ± 13.0 years, 61.0% females) were measured. Fifteen of the 118 patients (12.7%) developed an SSI. The groups differed with respect to existing hypertension, number of instrumented segments, region of surgery, CRPPOD1,7, PCTPOD7, and IL-6POD3,5,7. Binary logistic regression for SSI detection including these parameters showed an area under the curve (AUC) of 0.88 (95% CI 0.79-0.98; P < 0.001). The main effect for SSI detection was maintained by IL-6POD7 (odds ratio = 1.13; 95% CI 1.05-1.23; P = 0.001), which itself showed an AUC of 0.86 (95% CI 0.75-0.97).
CONCLUSIONS: Compared to CRP, WBC count, PCT, and TNF-α, IL-6 seems to be the critical IM for the early detection of an SSI.
BACKGROUND: drks.de: DRKS00033773, date of registration: 29.02.2024, retrospectively registered; Postoperative Markers of Inflammation in Spine Surgery (POMIS) Trial.