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Choi DH, Choi SW, Kim KH, Choi Y, Kim Y. Early identification of suspected serious infection among patients afebrile at initial presentation using neural network models and natural language processing: A development and external validation study in the emergency department. Am J Emerg Med 2024; 80:67-76. [PMID: 38507849 DOI: 10.1016/j.ajem.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To develop and externally validate models based on neural networks and natural language processing (NLP) to identify suspected serious infections in emergency department (ED) patients afebrile at initial presentation. METHODS This retrospective study included adults who visited the ED afebrile at initial presentation. We developed four models based on artificial neural networks to identify suspected serious infection. Patient demographics, vital signs, laboratory test results and information extracted from initial ED physician notes using term frequency-inverse document frequency were used as model variables. Models were trained and internally validated with data from one hospital and externally validated using data from a different hospital. Model discrimination was evaluated using area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CIs). RESULTS The training, internal validation, and external validation datasets comprised 150,699, 37,675, and 85,098 patients, respectively. The AUCs (95% CIs) for Models 1 (demographics + vital signs), 2 (demographics + vital signs + initial ED physician note), 3 (demographics + vital signs + laboratory tests), and 4 (demographics + vital signs + laboratory tests + initial ED physician note) in the internal validation dataset were 0.789 (0.782-0.796), 0.867 (0.862-0.872), 0.881 (0.876-0.887), and 0.911 (0.906-0.915), respectively. In the external validation dataset, the AUCs (95% CIs) of Models 1, 2, 3, and 4 were 0.824 (0.817-0.830), 0.895 (0.890-0.899), 0.879 (0.873-0.884), and 0.913 (0.909-0.917), respectively. Model 1 can be utilized immediately after ED triage, Model 2 can be utilized after the initial physician notes are recorded (median time from ED triage: 28 min), and Models 3 and 4 can be utilized after the initial laboratory tests are reported (median time from ED triage: 68 min). CONCLUSIONS We developed and validated models to identify suspected serious infection in the ED. Extracted information from initial ED physician notes using NLP contributed to increased model performance, permitting identification of suspected serious infection at early stages of ED visits.
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Affiliation(s)
- Dong Hyun Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae Won Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Ki Hong Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeongho Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yoonjic Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Ge Z, Liu X, Jing X, Wang J, Guo Y, Yang H, Cui X. Logistic regression model predicts early surgical site infection after spinal fusion: a retrospective cohort study. J Hosp Infect 2024; 149:65-76. [PMID: 38754784 DOI: 10.1016/j.jhin.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/27/2024] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study aimed to develop a diagnostic model for predicting early surgical site infection (SSI) based on postoperative inflammatory markers after spinal fusion surgery. METHODS In this retrospective study, we analysed the trends of inflammatory markers between SSI and non-SSI groups. The data were randomly divided into training cohort and validation cohort (ratio 7:3). The variables for SSI were analysed using stepwise logistic regression to develop the prediction model. To evaluate the model, we analysed its sensitivity, specificity, positive predictive value, negative predictive value, as well as the area under the curve in the validation cohort. Calibration plots and decision curve analysis were employed to assess the calibration and clinical usefulness of the model. FINDINGS We observed significant changes in inflammatory markers on the seventh day after surgery. The prediction model included four variables on the seventh day after surgery: body temperature, C-reactive protein, erythrocyte sedimentation rate and neutrophil counts. After binary processing of these data, the simplified model achieved an area under the curve of 0.86 (95% confidence interval (CI): 0.81-0.92) in the training cohort and 0.9 (95% CI: 0.82-0.98) in the validation cohort. Calibration plots and decision curve analysis demonstrated that the proposed model was effective for the diagnosis of SSI. CONCLUSION We developed and validated a prediction model for diagnosing early infection after spinal fusion.
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Affiliation(s)
- Z Ge
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - X Liu
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - X Jing
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - J Wang
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Y Guo
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - H Yang
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - X Cui
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China.
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Domagalska M, Ciftsi B, Janusz P, Reysner T, Daroszewski P, Kowalski G, Wieczorowska-Tobis K, Kotwicki T. Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block (ESPB) in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-Blinded, Controlled Trial. J Pediatr Orthop 2024:01241398-990000000-00549. [PMID: 38689466 DOI: 10.1097/bpo.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND This study aimed to compare the effect of the ultrasound-guided bilateral and bilevel erector spinae plane block (ESPB) on pain scores, opioid requirement, intraoperative motor-evoked potentials (MEPs), and stress response to surgery expressed by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) versus standard analgesia methods following idiopathic scoliosis surgery. METHODS This was a prospective, double-blinded, randomized controlled trial. Sixty patients aged 10 to 18 years and physical status ASA 1 or 2 were randomized into 2 equal groups, each receiving an ESPB or sham block. The primary outcome was the pain scores (Numerical Rating Scale, NRS) within 48 hours after spinal correction and fusion surgery for idiopathic thoracic scoliosis. The secondary outcomes were total opioid consumption, NLR, and PLR levels at 12 and 24 hours postoperatively and intraoperative MEPs. RESULTS ESPB patients presented lower NRS scores, signifying less pain, at all time points (30, 60, 90, 120 min; and 6, 12, 24, and 48 h after surgery), all P<0.0001. The total opioid consumption, the incidence of nausea or vomiting, and the need for remifentanil and propofol during surgery were significantly lower in the ESPB group. The surgery-induced stress response expressed by NLR and PLR was considerably lower in the ESPB group. ESPB did not affect the intraoperative MEP's amplitude. CONCLUSIONS ESPB is effective for postoperative analgesia, can reduce opioid consumption in patients undergoing scoliosis surgery, and reduces the stress response to surgery. ESPB does not interfere with neuromonitoring. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Bahadir Ciftsi
- Departments of Spine Disorders and Pediatric Orthopedics
| | - Piotr Janusz
- Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
| | - Tomasz Reysner
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences
| | - Przemysław Daroszewski
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Grzegorz Kowalski
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences
| | | | - Tomasz Kotwicki
- Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
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Osunronbi T, Olukoya O, Jesuyajolu D, Alare K, Alemenzohu HO, Bello RO, Omoniyo T, Oyeyemi OV, Yakasai AN, Sharma H. The prognostic utility of neutrophil-lymphocyte ratio in spinal surgery: A systematic review and meta-analysis. J Clin Neurosci 2024; 121:161-168. [PMID: 38412749 DOI: 10.1016/j.jocn.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Neutrophil-lymphocyte ratio (NLR) is reportedly an effective prognostic tool across various medical and surgical fields, but its value in spinal surgery is unestablished. We aim to investigate the relationship between elevated baseline/postoperative NLR and patient outcomes in spinal surgery. MATERIALS AND METHODS We performed a systematic search in PubMed, EMBASE, and SCOPUS databases for studies investigating the prognostic value of NLR in spine patients.Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were analysed on the RevMan 5.4 software. Where meta-analysis was not possible, we vote-counted the direction of the effect of elevated NLR. The GRADE framework for prognostic factor research was utilised to assess the certainty of the evidence for each outcome measure. RESULTS Five outcome measures (overall survival, mortality, disease-free survival, functional recovery and complications) were assessed across 16 studies involving 5471 patients. Elevated baseline NLR was associated with reduced overall survival (HR: 1.63, 95 % CI: 1.05 - 2.54) (GRADE: low) and worsened functional recovery (OR: 0.93, 95 % CI: 0.87 - 0.98) (GRADE: low). There was no association between baseline NLR and disease-free survival (HR: 2.42, 95 % CI: 0.49 - 11.83) (GRADE: very low) or mortality (OR: 1.39, 95 % CI: 0.41 - 4.75) (GRADE: very low). Elevated NLR levels measured on days 3-4 and days 6-7 postoperatively, but not NLR measured at baseline or on days 1-2 postoperatively, were associated with greater risks of complications (GRADE: low). CONCLUSIONS NLR is an objective tool with the potential to identify the patients that would benefit from surgery and facilitate shared decision-making.
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Affiliation(s)
- Temidayo Osunronbi
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria; Department of Health Sciences, University of York, York, United Kingdom.
| | - Olatomiwa Olukoya
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Kehinde Alare
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | | | - Raheem O Bello
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Taiwo Omoniyo
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Opeyemi V Oyeyemi
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Amina N Yakasai
- Neurosurgery Section, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Himanshu Sharma
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Takahashi T, Inose H, Hirai T, Matsukura Y, Morishita S, Egawa S, Hashimoto J, Takahashi K, Yoshii T. Factors associated with the time required for CRP normalization in pyogenic spondylitis: A retrospective observational study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100301. [PMID: 38225932 PMCID: PMC10788255 DOI: 10.1016/j.xnsj.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024]
Abstract
Background Treatment for pyogenic spondylitis tends to be prolonged; however, few studies have examined the factors associated with the time required for infection control. Therefore, we analyzed a consecutive cohort of patients to identify factors associated with the time required to control infection in pyogenic spondylitis. This study aimed to clarify the factors linked to the duration necessary for achieving infection control in cases of pyogenic spondylitis, using C-reactive protein (CRP) normalization as an indicator. Methods In this retrospective observational study, we investigated 108 patients diagnosed with pyogenic spondylitis. We evaluated the number of days from the first visit to CRP normalization; for cases wherein CRP did not normalize, the number of days to the date of final blood sampling was evaluated. In the present study, infection control in pyogenic spondylitis was defined as a CRP falling within the normal range (≤0.14 mg/dL). We performed univariate and multivariate Cox regression analyses to identify various factors associated with the time required for CRP normalization in pyogenic spondylitis. Results The mean time required for CRP normalization was 148 days. Univariate Cox regression analysis showed that the serum creatinine level, estimated glomerular filtration rate (eGFR), lymphocyte percentage, neutrophil percentage, CRP level, CRP-albumin ratio, and neutrophil-to-lymphocyte ratio were significantly associated with the time required to control infection. Multivariate Cox regression analysis showed that a higher neutrophil percentage, diabetes mellitus, and a lower eGFR were the independent factors associated with a longer infection control time. Conclusions We found that a higher neutrophil percentage, diabetes mellitus, and a lower eGFR were significantly associated with a longer time for CRP normalization in pyogenic spondylitis. These findings may help identify patients with pyogenic spondylitis who are at a high risk for an extended infection control period.
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Affiliation(s)
- Takuya Takahashi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Hiroyuki Inose
- Department of Orthopedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Jun Hashimoto
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10 Kanda Surugadai, Chiyoda-ku, Tokyo 101‑0062, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Domagalska M, Ciftsi B, Janusz P, Reysner T, Kolasinski J, Wieczorowska-Tobis K, Kowalski G. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels following erector spinae plane block (ESPB) in posterior lumbar decompression: a randomized, controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4192-4199. [PMID: 37668689 DOI: 10.1007/s00586-023-07913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/26/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are the inflammatory biomarkers of the stress response. In this study, we aimed to evaluate the effects of erector spinae plane block (ESPB) on posterior lumbar decompression and stabilization by comparing NLR, PLR, postoperative pain, opioid consumption, and functional recovery between sham block and ESPB. METHODS This was a prospective, double-blinded, randomized controlled trial in a tertiary referral hospital. Sixty patients were randomized into two equal groups, each receiving either a sham block or ESPB. The primary outcome was the NLR and PLR 12 h and 24 h after lumbar posterior decompression and stabilization. The secondary outcomes were total opioid consumption and pain score 24 h postoperatively. Also, functional recovery determined by getting out of bed, verticalization, and walking by the balcony were reviewed as secondary outcomes. RESULTS Significant differences existed between the sham block and ESPB group in NLR (29.08 ± 12.29 vs. 16.97 ± 10.38; p < 0.0001) and PLR (556.77 ± 110.32 vs. 346.43 ± 117.34; p < 0.0001) 12 h after surgery. Also, there was a significant difference in NLR (p = 0.0466) and PLR (p < 0.0001) 24 h after surgery. In addition, there was a substantial difference in pain score, total opioid consumption, and functional recovery. CONCLUSION ESPB performance during spinal surgery lowers NRL and PLR ratios 12 h and 24 h after surgery. In addition, ESPB provides better analgesia and improves functional recovery compared to sham block following posterior lumbar decompression and stabilization.
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Affiliation(s)
- Małgorzata Domagalska
- Chair and Department of Palliative Medicine, University of Medical Sciences, Os.Rusa 55, 61-245, Poznań, Poland.
| | - Bahadir Ciftsi
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Piotr Janusz
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznań, Poland
| | - Tomasz Reysner
- Chair and Department of Palliative Medicine, University of Medical Sciences, Os.Rusa 55, 61-245, Poznań, Poland
| | | | | | - Grzegorz Kowalski
- Chair and Department of Palliative Medicine, University of Medical Sciences, Os.Rusa 55, 61-245, Poznań, Poland
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Qian B, Zheng Y, Jia H, Zheng X, Gao R, Li W. Neutrophil-lymphocyte ratio as a predictive marker for postoperative infectious complications: A systematic review and meta-analysis. Heliyon 2023; 9:e15586. [PMID: 37159687 PMCID: PMC10163603 DOI: 10.1016/j.heliyon.2023.e15586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
Objective Postoperative infection is a common but costly complication. The neutrophil-lymphocyte ratio is a promising marker for the identification of postsurgical infectious events. We aimed to perform this meta-analysis to assessed the accuracy of the neutrophil-lymphocyte ratio for the prediction of postsurgical infection. Methods We searched PubMed, Embase, Web of Science, and Cochrane Library without language restriction from their inceptions to April 2022, and checked reference lists of included studies. Studies were included if they assessed predictive accuracy of neutrophil-lymphocyte ratio for postsurgical infection. We estimated its predictive value and explored the source of heterogeneity. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess methodological quality and the Deeks' test to evaluate publication bias. The bivariate model and hierarchical summary receiver operating characteristic (HSROC) curve were used for meta-analysis and generated a summary receiver operating characteristic space (ROC) curve. Results Our search returned 379 reports, of which 12 fulfilled the inclusion criteria, accounting for 4375 cases. The bivariate analysis yielded a pooled sensitivity of 0.77 (95%C.I.: 0.65-0.85) and specificity of 0.78 (95%C.I.: 0.67-0.86). Pooled positive LR and negative LR were 3.48 (95%C.I.: 2.26-5.36) and 0.30 (95%C.I.: 0.20-0.46), respectively. A negative LR of 0.30 reduces the post-test probability to 2% for a negative test result. The area under of receiver operating characteristic curve was 0.84 (95%C.I.: 0.80-0.87). Subgroups comparisons revealed difference by study design, surgical site, presentence of implant, time of sampling, type of infection event and prevalence of infection. The Deeks' test showed no publication bias. The sensitivity analysis showed no study affected the robustness of combined results. Conclusions Low-certainty evidence suggests that the neutrophil-lymphocyte ratio is a helpful marker for predicting postoperative infectious complication. The negative predictive value of the neutrophil-lymphocyte ratio enables for reliable exclusion of postoperative infection.Trial registrationPROSPERO registration number CRD42022321197. Registered on 27 April 2022.
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Wang Y, Qu Z, Liang W, Chen X, Chen C, Cheng H, Hu H, Wei Z, Su K, Yang L, Wang H. Clinical features and markers to identify pulmonary lesions caused by infection or vasculitis in AAV patients. BMC Pulm Med 2023; 23:27. [PMID: 36653805 PMCID: PMC9850570 DOI: 10.1186/s12890-023-02317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Pulmonary lesion is frequently seen in ANCA-associated vasculitis (AAV) patients primarily due to AAV lung involvement or infection, which are hard to differentiate due to their high similarity in clinical manifestations. We aimed to analyze the clinical features of pulmonary lesions consequent to AAV involvement or infection in AAV patients and further identify the markers for differential diagnosis. METHODS 140 AAV patients who admitted to the Renmin Hospital of Wuhan University from January 2016 to July 2021 were included in this study. According to the nature of lung conditions, these patients were divided into the non-pulmonary lesion group, the lung infection group and the non-pulmonary infection group, and their demographics, clinical symptoms, imaging features, as well as laboratory findings were compared. A receiver operating characteristic (ROC) curve was drawn, and the diagnostic efficacy of single biomarker and composite biomarkers on pulmonary infection was then evaluated. RESULTS The patients in the lung infection group were significantly older than those in the no lesion group (63.19 ± 14.55 vs 54.82 ± 15.08, p = 0.022). Patients in the lung infection group presented more frequent symptoms and more obvious pulmonary image findings. Compared with patients in the non-pulmonary infection group, patients in the lung infection group showed a higher symptom incidence of fever, chest tightness, cough and expectoration, and hemoptysis (52.94% vs 16.00%, 61.76% vs 40.00%, 72.06% vs 46.00%, 27.94% vs 8.00%, p < 0.05, respectively), and more changes in pulmonary CT scanning images in terms of patched/striped compact opacity, alveolar hemorrhage, bronchiectasis, pleural effusion, as well as mediastinal lymphadenopathy (89.71% vs 52.00%, 11.76% vs 2.00%, 22.06% vs 8.00%, 50.00% vs 20.00%, 48.53% vs 24.00%, p < 0.05, respectively). In addition, patients in the lung infection group had significantly higher levels of serum pro-calcitonin (PCT), C-reactive protein (CRP), amyloid A (SAA), blood neutrophil-to-lymphocyte ratio (NLCR), erythrocyte sedimentation rate (ESR), as well as Birmingham vasculitis activity score (BVAS) than patients in the other two groups (p < 0.05). Among all biomarkers, PCT exhibited the highest diagnostic efficacy (0.928; 95%CI 0.89-0.97) for pulmonary infected AAV patients at a cut-off score of 0.235 ng/ml with 85.3% sensitivity and 84% specificity. Moreover, the composite biomarker of PCT-CRP-NLCR showed more diagnostic efficacy (0.979; 95% CI 0.95-1.00) in distinguishing the infectious and non-infectious lung injuries in AAV patients. CONCLUSIONS AAV patients with lung infection manifested more clinical symptoms and prominent lung image changes. The PCT and composite biomarker PCT-CRP-NLCR showed high diagnostic efficacy for a lung infection in AAV patients. Pulmonary lesion caused by either infection or AAV involvement is commonly seen and difficult to distinguish. We aim to identify the biomarkers that can be applied in the differentiation diagnosis of pulmonary lesions in AAV patients.
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Affiliation(s)
- Yujuan Wang
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Zhuan Qu
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Wei Liang
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Xinghua Chen
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Cheng Chen
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Hui Cheng
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Haiyun Hu
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Zhongpin Wei
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Ke Su
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Lianhua Yang
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
| | - Huiming Wang
- grid.412632.00000 0004 1758 2270Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060 Hubei Province People’s Republic of China
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TUĞRUL ERSAK D, ERSAK B, ZORLU U, KOKANALI MK, MORALOĞLU TEKİN Ö, DOĞANAY M. Düşük riskli kadınlarda enfekte epizyotomi riskini öngören bir model. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Infected episiotomy (IE) is a rare complication of vaginal delivery. However, the practical use of the risk factors involved in the development of IE is unclear. The aim of this study is to create a risk scoring model to be applied in clinical practice with the risk factors we will determine so as to predict the development of IE.
Materials and Methods: All women who were delivered vaginally with mediolateral episiotomy within a 1-year period were included in this retrospective study. While 42 women (cases) with the diagnosis of IE were eligible for inclusion in the study and formed the case group, randomly selected 168 women in whom IE was not detected formed the control group. Possible risk factors for the development of IE were evaluated by multivariate regression analysis.
Results: The analysis revealed 5 significant independent factors related to IE. Among these factors, 5 points were given to current smoking presence, 4 points to weight gain during pregnancy ≥11.5 kg, 3 points to postpartum neutrophil to lymphocyte ratio ≥10.4, 2 points to presence of diabetes mellitus, and 1 point to presence of hospitalization before active phase of labor. And a cut-off value of 5.5 was found to be moderately effective in predicting IE.
Conclusion: Consequently, this five-variable model can predict the presence of IE with significant efficiency. In the presence of these variables, the clinician can identificate the patients at risk of IE. In this way, individualized patient risk assessment and situation-specific counseling can be made.
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Affiliation(s)
- Duygu TUĞRUL ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Burak ERSAK
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Uğurcan ZORLU
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Mahmut Kuntay KOKANALI
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Özlem MORALOĞLU TEKİN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
| | - Melike DOĞANAY
- UNIVERSITY OF HEALTH SCIENCES, ANKARA DR. ZEKAİ TAHİR BURAK HEALTH RESEARCH CENTER FOR WOMEN'S HEALTH
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10
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Miyazaki K, Jwa SC, Katayama E, Tamaru S, Ishihara O, Kamei Y. Postoperative C-reactive protein as a predictive marker for surgical site infection after cesarean section: Retrospective analysis of 748 patients at a Japanese academic institution. PLoS One 2022; 17:e0273683. [PMID: 36083881 PMCID: PMC9462722 DOI: 10.1371/journal.pone.0273683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Surgical site infection (SSI) is a common but potentially serious maternal complication of cesarean section (CS). C-reactive protein (CRP) can be used in early detection of SSI. However, its predictive value for post-cesarean SSI has never been investigated. This study aims to evaluate the predictive value of CRP for the development of SSI. This was a hospital-based retrospective cohort study of 748 pregnant women who underwent CS at our university hospital between January 2017 and December 2019. CRP was measured on postoperative days 1, 3, and 6. The predictive values of CRP for SSI were evaluated using receiver operating characteristics analysis. Forty-seven (6.3%) patients developed SSI, of whom 38 (80.9%) underwent emergency CS. Serum CRP levels were significantly higher in the SSI group than in the non-SSI group from postoperative day 1 (64 vs. 81 mg/L, p = 0.001); the difference became more evident on postoperative days 3 and 6. The area under the receiver operating characteristic curve (AUC) for CRP on days 1, 3, and 6 was 0.58 (95% confidence interval [CI], 0.49 to 0.68), 0.70 (0.62 to 0.78) and 0.73 (0.65 to 0.81), respectively. The optimal cutoff value for day 3 and 6 CRP was 66.4 mg/L (sensitivity = 76.1% and specificity = 54.4%) and 22.2 mg/L (sensitivity = 76.5% and specificity = 63.2%), respectively. CRP on postoperative days 3 and 6 can be used as a predictive marker for the development of SSI after CS. Further studies to validate the predictive value in different populations is essential.
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Affiliation(s)
- Kazuko Miyazaki
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
- * E-mail:
| | - Eri Katayama
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Shunsuke Tamaru
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
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11
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Parla K, Tatli AB, Pala AA, Goncu MT. The ımportance of ınflammatory parameters ın predıctıng deep sternal wound ınfectıons after open heart surgery. Rev Assoc Med Bras (1992) 2022; 68:1185-1190. [PMID: 36074386 PMCID: PMC9575039 DOI: 10.1590/1806-9282.20220140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between the development of deep sternal wound infection after open heart surgery and inflammatory parameters obtained from routine biochemical tests. METHODS A total of 280 patients who underwent cardiac surgery with median sternotomy between January 2015 and January 2020 were examined retrospectively. Patients who developed deep sternal wound infection were identified as "Group 1," and those who did not develop deep sternal wound infection were identified as "Group 2." RESULTS There were 70 patients with a mean age of 61.6±9.9 years in Group 1 and 210 patients with a mean age of 62.7±9.8 years in Group 2. As a result of the analysis, it was found that the presence of concomitant chronic obstructive pulmonary disease, concomitant diabetes mellitus, blood and blood product transfusion, postoperative 2nd day C-reactive protein, postoperative 1st day neutrophil-to-lymphocyte ratio, and delta neutrophil-to-lymphocyte ratio was found as independent predictive factors of postoperative deep sternal wound infection development (p=0.043, p=0.012, p=0.029, p=0.009, p=0.002, and p<0.001; respectively). As a predictor of deep sternal wound infections development, postoperative 1st day neutrophil-to-lymphocyte ratio cutoff value was 11.2 (area under the curve [AUC] 0.598; p=0.014; 60% sensitivity, and 65.2% specificity), and delta neutrophil-to-lymphocyte ratio cutoff value was 9.6 (AUC 0.716; p<0.001; 57.1% sensitivity, and 73.8% specificity). CONCLUSIONS Deep sternal wound infection development can be predicted with inflammatory parameters such as neutrophil-to-lymphocyte ratio and C-reactive protein that are obtained from cheap and easily available routine biochemical tests.
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Affiliation(s)
- Kemal Parla
- University of Health Sciences, Van Training and Research Hospital, Department of Cardiovascular Surgery - Van, Turkey
| | - Ahmet Burak Tatli
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery - Bursa, Turkey
| | - Arda Aybars Pala
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery - Bursa, Turkey
| | - Mehmet Tugrul Goncu
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery - Bursa, Turkey
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12
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Iwata E, Shigematsu H, Yamamoto Y, Ikejiri M, Okuda A, Sada T, Ueno Y, Nakajima H, Koizumi M, Tanaka Y. Temporal Evolution of White Blood Cell Count and Differential: Reliable and Early Detection Markers for Surgical Site Infection Following Spinal Posterior Decompression Surgery. Spine Surg Relat Res 2022; 6:271-278. [PMID: 35800621 PMCID: PMC9200420 DOI: 10.22603/ssrr.2021-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction For early detection of surgical site infection (SSI) following spinal decompression surgery, we compared temporal changes in the values of laboratory markers that are not affected by operative parameters. Methods The study included 302 patients, which were divided into an SSI group (patients who developed deep SSI) and a non-SSI group for analysis. We reviewed data on C-reactive protein level, total white blood cell (WBC) count, and WBC differential percentage and count before spinal decompression, on postoperative day 1, and on postoperative day 4. We identified laboratory markers that are not affected by operative parameters (operating time, intraoperative blood loss, and number of operative segments). Laboratory markers with a significant difference observed between the peak or nadir value and the value in the subsequent survey day were considered as an indicator of SSI. We examined the utility of each indicator by calculating sensitivity and specificity. Furthermore, we investigated the utility of the combination of all five indicators (wherein the recognition of one marker was considered positive). Results Temporal changes in five laboratory markers were considered indicators of SSI. The changes from postoperative day 1 to postoperative day 4 were as follows: (1) increased WBC count (42% sensitivity, 88% specificity), (2) increased neutrophil percentage (25% sensitivity, 96% specificity), (3) increased neutrophil count (25% sensitivity, 94% specificity), (4) decreased lymphocyte percentage (25% sensitivity, 95% specificity), and (5) decreased lymphocyte count (25% sensitivity, 85% specificity). The combination of these five markers showed a 50% sensitivity, 81% specificity, and 0.65 AUC. Conclusions Five markers were found to be reliable indicators of SSI following spinal decompression surgery because they were not affected by operative parameters. The combination of all five indicators had moderate sensitivity and high specificity. Therefore, this may be reliable and useful for the early detection of SSI.
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Affiliation(s)
| | | | | | - Masaki Ikejiri
- Department of Orthopedic Surgery, Nara Medical University
| | - Akinori Okuda
- Department of Orthopedic Surgery, Nara Medical University
| | - Takuya Sada
- Department of Orthopedic Surgery, Nara City Hospital
| | - Yuki Ueno
- Department of Orthopedic Surgery, Nara City Hospital
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13
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Osunronbi T, Borbas B, Lusta H, Sofela A, Sharma H. Preoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful predictors of 30-day postoperative complications after lumbar fusion. Surg Neurol Int 2022; 13:145. [PMID: 35509554 PMCID: PMC9062943 DOI: 10.25259/sni_160_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Lymphocyte percentage/count, platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) have shown prognostic significance in patients with cancer, stroke, and following cardiac surgery. However, the utility of these blood parameters for assessing the 30-day postoperative risk for lumbar fusion complications has not been established. Methods: In this single-center-single-surgeon retrospective series, 77 consecutive patients underwent one- or two-level lumbar fusion. Lymphocyte percentage/count, PLR, and NLR were investigated as predictors of 30-day postoperative complications. Results: Ten of 77 patients had postoperative complications. A unit increase in NLR and lymphocyte percentage was significantly associated with a 23% increase and 7% decrease, respectively, in the odds of a complication occurring. Preoperative NLR ≥ 2.32 and lymphocyte percentage ≤ 29.5% significantly discriminated between the “complication” and “no-complication” groups. Conclusion: Patients with a preoperative lymphocyte percentage of ≤29.5% and/or NLR ≥2.32 should be closely monitored as high-risk groups susceptible to 30-day postoperative complications after lumbar fusion.
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Affiliation(s)
- Temidayo Osunronbi
- Department of Surgery, Hull University Teaching Hospitals NHS Trust, Anlaby Road, Hull,
- Department of Health Sciences, University of York, York,
| | - Balint Borbas
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth Science Park, Plymouth,
| | - Hiba Lusta
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth Science Park, Plymouth,
| | - Agbolahan Sofela
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Himanshu Sharma
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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14
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Inose H, Kobayashi Y, Morishita S, Matsukura Y, Yuasa M, Hirai T, Yoshii T, Okawa A. Application of an index derived from the area under a neutrophil curve as a predictor of surgical site infection after spinal surgery. BMC Surg 2021; 21:354. [PMID: 34579693 PMCID: PMC8477575 DOI: 10.1186/s12893-021-01345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients with prolonged and intense neutrophilia after spinal surgery are at high risk of developing surgical site infection (SSI). To date, there is no standard method for the objective assessment of the intensity and duration of neutrophilia. Thus, this retrospective observational study aimed to test a new index (I-index), developed by combining the duration and intensity of neutrophilia, as a predictor of SSI. Methods I-index was calculated based on the postoperative neutrophil percentage. A total of 17 patients with SSI were enrolled as cases, and 51 patients without SSI were selected as controls. The groups were matched at a ratio of 1:3 by age, sex, and surgery type. The differences in the I-index were compared between the groups. Moreover, we checked the cumulative I-index (c-I-index), which we defined as the area under the neutrophil curve from postoperative day 1 until the first clinical manifestation of SSI in each case. Furthermore, a cutoff for SSI was defined using the receiver operating characteristic curve. Results The median I-index-7, I-index-14, and c-I-index were significantly higher in the SSI group than those in the control group. For a cutoff point of 42.1 of the I-index-7, the sensitivity and specificity were 0.706 and 0.882, respectively. For a cutoff point of 45.95 of the I-index-14, the sensitivity and specificity were 0.824 and 0.804, respectively. For a cutoff point of 45.95 of the c-I-index, the sensitivity and specificity were 0.824 and 0.804, respectively. Conclusion We devised a new indicator of infection, i.e., the I-Index and c-I-index, and confirmed its usefulness in predicting SSI.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yutaka Kobayashi
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masato Yuasa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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15
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Sim JH, Lee JS, Jang DM, Kim HJ, Lee SW, Cho HS, Choi WJ. Effects of Perioperative Inflammatory Response in Cervical Cancer: Laparoscopic versus Open Surgery. J Clin Med 2021; 10:jcm10184198. [PMID: 34575308 PMCID: PMC8467117 DOI: 10.3390/jcm10184198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 12/31/2022] Open
Abstract
There are few studies between postoperative neutrophil to lymphocyte ratio (NLR) and survival in cervical cancer. We compared postoperative changes in NLR according to surgical methods and analyzed the effect of these changes on 5-year mortality of cervical cancer patients. A total of 929 patients were assigned to either the laparoscopic radical hysterectomy (LRH) (n = 721) or open radical hysterectomy (ORH) (n = 208) group. Propensity score matching analysis compared the postoperative NLR changes between the two groups, and multivariate logistic regression analysis evaluated the association between NLR changes and 5-year mortality. Surgical outcomes between the two groups were also compared. In the LRH group, NLR changes at postoperative day (POD) 0 and POD 1 were significantly lower than in the ORH group after matching (NLR change at POD 0, 10.4 vs. 14.3, p < 0.001; NLR change at POD 1, 3.5 vs. 5.4, p < 0.001). In multivariate logistic regression analysis, postoperative NLR change was not associated with 5-year mortality (2nd quartile: OR 1.55, 95% CI 0.56–4.29, p = 0.401; 3rd quartile: OR 0.90, 95% CI 0.29–2.82, p = 0.869; 4th quartile: OR 1.40, 95% CI 0.48–3.61, p = 0.598), whereas preoperative NLR was associated with 5-year mortality (OR 1.23, 95% CI 1.06–1.43, p = 0.005). After matching, there were no significant differences in surgical outcomes between the two groups. There were significantly fewer postoperative changes of NLR in the LRH group. However, the extent of these NLR changes was not associated with 5-year mortality. By contrast, preoperative NLR was associated with 5-year mortality.
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Affiliation(s)
- Ji-Hoon Sim
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
| | - Ju-Seung Lee
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
| | - Dong-Min Jang
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
| | - Hwa Jung Kim
- Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Shin-Wha Lee
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Hyun-Seok Cho
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
- Correspondence: ; Tel.: +82-2-3010-0807; Fax: +82-2-3010-6790
| | - Woo-Jong Choi
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
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16
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Kijima H, Tateda K, Yamada S, Nagoya S, Fujii M, Kosukegawa I, Kawano T, Miyakoshi N, Yamashita T, Shimada Y. Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:11795441211031340. [PMID: 34345193 PMCID: PMC8280835 DOI: 10.1177/11795441211031340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
Purpose: Muscle-sparing approaches for total hip replacement (THR) involve learning
curves. This study aimed to clarify changes in invasiveness and infection
rate with changes in approach. Methods: One surgeon changed the approach of THR from Dall’s approach (Dall) to
anterolateral modified Watson-Jones approach (OCM). Another changed from
Dall to a direct anterior approach (DAA). Another 3 surgeons changed from
posterolateral approach (PL) to OCM. Subjects were 150 cases, comprising the
last 25 cases with conventional approaches and the first 25 cases with new
approaches (Dall to OCM: 25 + 25; Dall to DAA: 25 + 25; PL to OCM: 25 + 25
cases). Differences in operative time, bleeding volume, hospital stay,
haemoglobin (Hb), white blood cell count, lymphocyte count, creatine kinase
(CK) and C-reactive protein (CRP) were investigated. Results: In the change from Dall to OCM, only hospital stay decreased. In the change
from Dall to DAA, hospital stay and CRP decreased, but bleeding volume
increased. In the change from PL to OCM, operative time, CRP and CK
decreased, but Hb also decreased. Cases with lymphocyte count <1000/μL or
lymphocytes comprising <10% of total white blood cells at around day 4
after surgery were defined as latent infection cases. In these cases,
operative time was longer, Hb was lower and CK was higher. Conclusion: Introducing muscle-sparing approaches improved many markers of invasiveness,
but some items deteriorated. In the early stages of introducing a new
approach, choosing cases without obesity and without high muscle volume may
reduce the risk of infection.
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Affiliation(s)
- Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenji Tateda
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shin Yamada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoshi Nagoya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masashi Fujii
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ima Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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