Procalcitonin and Neutrophil Lymphocyte Ratio After Spinal Instrumentation Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Dec 2019
01 Dec 2019
Historique:
entrez:
15
11
2019
pubmed:
15
11
2019
medline:
7
2
2020
Statut:
ppublish
Résumé
This was a retrospective observational study. To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery. Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated. We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis. Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688). Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study. 4.
Sections du résumé
STUDY DESIGN
METHODS
This was a retrospective observational study.
OBJECTIVE
OBJECTIVE
To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated.
METHODS
METHODS
We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis.
RESULTS
RESULTS
Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688).
CONCLUSION
CONCLUSIONS
Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study.
LEVEL OF EVIDENCE
METHODS
4.
Identifiants
pubmed: 31725684
doi: 10.1097/BRS.0000000000003157
pii: 00007632-201912010-00005
doi:
Substances chimiques
Biomarkers
0
Procalcitonin
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E1356-E1361Références
Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010; 303:1259–1265.
Kepler CK, Vaccaro AR, Hilibrand AS, et al. National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 2014; 39:1584–1589.
Inose H, Kato T, Yuasa M, et al. Comparison of decompression, decompression plus fusion, and decompression plus stabilization for degenerative spondylolisthesis: a prospective, randomized study. Clin Spine Surg 2018; 31:E347–E352.
Tominaga H, Setoguchi T, Kawamura H, et al. Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: a retrospective case-control study. Medicine (Baltimore) 2016; 95:e5118.
Lieber B, Han B, Strom RG, et al. Preoperative predictors of spinal infection within the National Surgical Quality Inpatient Database. World Neurosurg 2016; 89:517–524.
Iwata E, Shigematsu H, Koizumi M, et al. Lymphocyte count at 4 days postoperatively and CRP level at 7 days postoperatively: reliable and useful markers for surgical site infection following instrumented spinal fusion. Spine (Phila Pa 1976) 2016; 41:1173–1178.
Chalupa P, Beran O, Herwald H, et al. Evaluation of potential biomarkers for the discrimination of bacterial and viral infections. Infection 2011; 39:411–417.
Nobre V, Borges I, Núcleo Interdisciplinar de Investigação em Medicina I. Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections. Rev Bras Ter Intensiva 2016; 28:179–189.
Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011; 9:107.
Lee H. Procalcitonin as a biomarker of infectious diseases. Korean J Intern Med 2013; 28:285–291.
Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39:206–217.
Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341:515–518.
Murray CK, Hoffmaster RM, Schmit DR, et al. Evaluation of white blood cell count, neutrophil percentage, and elevated temperature as predictors of bloodstream infection in burn patients. Arch Surg 2007; 142:639–642.
Takahashi J, Shono Y, Hirabayashi H, et al. Usefulness of white blood cell differential for early diagnosis of surgical wound infection following spinal instrumentation surgery. Spine (Phila Pa 1976) 2006; 31:1020–1025.
Lowsby R, Gomes C, Jarman I, et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J 2015; 32:531–534.
Naess A, Nilssen SS, Mo R, et al. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection 2017; 45:299–307.
Cai YJ, Dong JJ, Dong JZ, et al. Neutrophil-lymphocyte ratio predicts hospital-acquired bacterial infections in decompensated cirrhosis. Clin Chim Acta 2017; 469:201–207.
Committee on Clinical Practice Guideline on the Prevention of Surgical Site Infections in Bone and Joint. The Japanese Orthopaedic Association (JOA) Clinical Practice Guideline on the Prevention of Surgical Site Infections in Bone and Joint.ed. Japan: Nankodo; 2015.
Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control 1999; 27:97–132.
Aljabi Y, Manca A, Ryan J, et al. Value of procalcitonin as a marker of surgical site infection following spinal surgery. Surgeon 2019; 17:97–101.
Povsic MK, Beovic B, Ihan A. Perioperative increase in neutrophil CD64 expression is an indicator for intra-abdominal infection after colorectal cancer surgery. Radiol Oncol 2017; 51:211–220.