Mok James M, Pekmezci Murat, Piper Samantha L, Boyd Erin, Berven Sigurd H, Burch Shane, Deviren Vedat, Tay Bobby, Hu Serena S
Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143-0728, USA.
Spine (Phila Pa 1976). 2008 Feb 15;33(4):415-21. doi: 10.1097/BRS.0b013e318163f9ee.
This is a prospective observational study of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in a cohort of patients undergoing spinal surgery.
We sought to characterize the normal kinetics of ESR and CRP after spinal surgery and compare their usefulness as predictors of infectious complications in the early postoperative period.
ESR and CRP are nonspecific markers of inflammation used to evaluate postoperative infection. CRP is a quantitative test that exhibits predictable kinetics consisting of a postoperative rise and a peak followed by a decrease toward the normal value. Deviation from normal kinetics may be an indicator of infection.
ESR and CRP were collected before surgery and daily after surgery in consecutive patients. All infectious complications were recorded.
One hundred forty-nine patients met inclusion criteria. Infectious complications occurred in 20 patients. A postoperative peak, which is necessary to apply the test, was observed in 78% of patients for CRP and 48% for ESR. Multiple linear regression analysis revealed preoperative CRP, number of levels, and lumbar region as significant predictors of greater CRP peak value (r = 0.435, P = 0.001). After the peak, CRP showed an exponential decrease with a half-life of 2.6 days (r = 0.701, P < 0.001). No trend could be determined for ESR. A second rise or failure to decrease as expected had a sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 48%, 41%, and 86% for infectious complications, respectively. Of 8 cases of deep wound infection, 7 exhibited substantial deviations from expected CRP values.
CRP is more applicable, predictable, and responsive in the early postoperative period compared with ESR. The postoperative kinetics of CRP derived in this study seems to be conserved regardless of operation, magnitude, or region. Knowledge of the kinetics allows assessment of the degree of difference between actual and expected values. Using a second rise or failure to decrease as expected for CRP is sensitive for infection. A negative test is reassuring that infection is unlikely.
这是一项对接受脊柱手术患者队列中的红细胞沉降率（ESR）和C反应蛋白（CRP）进行的前瞻性观察研究。
我们试图描述脊柱手术后ESR和CRP的正常变化规律，并比较它们在术后早期作为感染并发症预测指标的有效性。
ESR和CRP是用于评估术后感染的非特异性炎症标志物。CRP是一种定量检测，其变化规律可预测，包括术后升高、达到峰值，随后降至正常水平。偏离正常变化规律可能是感染的一个指标。
连续纳入的患者在手术前及术后每日采集ESR和CRP。记录所有感染并发症。
149例患者符合纳入标准。20例患者发生感染并发症。78%的患者CRP出现术后峰值（这是应用该检测所必需的），48%的患者ESR出现术后峰值。多元线性回归分析显示，术前CRP、手术节段数和腰椎区域是CRP峰值更高的显著预测因素（r = 0.435，P = 0.001）。达到峰值后，CRP呈指数下降，半衰期为2.6天（r = 0.701，P < 0.001）。ESR未发现明显趋势。第二次升高或未按预期下降对感染并发症的敏感性、特异性、阳性预测值和阴性预测值分别为82%、48%、41%和86%。在8例深部伤口感染病例中，7例的CRP值与预期值有显著偏差。
与ESR相比，CRP在术后早期更适用、更具可预测性且反应更灵敏。本研究得出的CRP术后变化规律似乎不受手术方式、手术范围或手术部位的影响。了解这种变化规律有助于评估实际值与预期值之间的差异程度。利用CRP第二次升高或未按预期下降来检测感染具有较高的敏感性。检测结果为阴性则提示感染可能性不大。
