Tarabichi Majd, Shohat Noam, Kheir Michael M, Adelani Muyibat, Brigati David, Kearns Sean M, Patel Pankajkumar, Clohisy John C, Higuera Carlos A, Levine Brett R, Schwarzkopf Ran, Parvizi Javad, Jiranek William A
Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel.
J Arthroplasty. 2017 Sep;32(9S):S263-S267.e1. doi: 10.1016/j.arth.2017.04.065. Epub 2017 May 11.
Although HbA1c is commonly used for assessing glycemic control before surgery, there is no consensus regarding its role and the appropriate threshold in predicting adverse outcomes. This study was designed to evaluate the potential link between HbA1c and subsequent periprosthetic joint infection (PJI), with the intention of determining the optimal threshold for HbA1c.
This is a multicenter retrospective study, which identified 1645 diabetic patients who underwent primary total joint arthroplasty (1004 knees and 641 hips) between 2001 and 2015. All patients had an HbA1c measured within 3 months of surgery. The primary outcome of interest was a PJI at 1 year based on the Musculoskeletal Infection Society criteria. Secondary outcomes included orthopedic (wound and mechanical complications) and nonorthopedic complications (sepsis, thromboembolism, genitourinary, and cardiovascular complications). A regression analysis was performed to determine the independent influence of HbA1c for predicting PJI.
Overall 22 cases of PJI occurred at 1 year (1.3%). HbA1c at a threshold of 7.7 was distinct for predicting PJI (area under the curve, 0.65; 95% confidence interval, 0.51-0.78). Using this threshold, PJI rates increased from 0.8% (11 of 1441) to 5.4% (11 of 204). In the stepwise logistic regression analysis, PJI remained the only variable associated with higher HbA1c (odds ratio, 1.5; confidence interval, 1.2-2.0; P = .0001). There was no association between high HbA1c levels and other complications assessed.
High HbA1c levels are associated with an increased risk for PJI. A threshold of 7.7% seems to be more indicative of infection than the commonly used 7% and should perhaps be the goal in preoperative patient optimization.
尽管糖化血红蛋白（HbA1c）常用于术前评估血糖控制情况，但对于其在预测不良结局中的作用及合适阈值尚无共识。本研究旨在评估HbA1c与随后的人工关节周围感染（PJI）之间的潜在联系，以确定HbA1c的最佳阈值。
这是一项多中心回顾性研究，纳入了2001年至2015年间接受初次全关节置换术的1645例糖尿病患者（1004例膝关节置换和641例髋关节置换）。所有患者在手术3个月内检测了HbA1c。主要关注结局是基于肌肉骨骼感染学会标准的1年时的PJI。次要结局包括骨科并发症（伤口和机械并发症）和非骨科并发症（脓毒症、血栓栓塞、泌尿生殖系统和心血管并发症）。进行回归分析以确定HbA1c对预测PJI的独立影响。
1年时共发生22例PJI（1.3%）。HbA1c阈值为7.7时对预测PJI具有显著意义（曲线下面积为0.65；95%置信区间为0.51 - 0.78）。采用此阈值时，PJI发生率从0.8%（共1441例中的11例）升至5.4%（共204例中的11例）。在逐步逻辑回归分析中，PJI仍然是与较高HbA1c相关的唯一变量（比值比为1.5；置信区间为1.2 - 2.0；P = 0.0001）。高HbA1c水平与评估的其他并发症之间无关联。
高HbA1c水平与PJI风险增加相关。7.7%的阈值似乎比常用的7%更能提示感染风险，或许应作为术前患者优化的目标。
