Jiménez-Garrido C, Gómez-Palomo J M, Rodríguez-Delourme I, Durán-Garrido F J, Nuño-Álvarez E, Montañez-Heredia E
Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Campus Teatinos, s/n, Málaga, Spain.
Department of Internal Medicine, Hospital Universitario Virgen de la Victoria, Campus teatinos, s/n, Málaga, Spain.
Int Orthop. 2018 Jan;42(1):33-38. doi: 10.1007/s00264-017-3670-4. Epub 2017 Oct 26.
This work seeks to verify the utility of the KLIC score as a predictor of treatment success or failure in patients with knee and hip acute prosthetic joint infections (APJI). These patients were treated in our centre, which is not a prosthetic joint infection reference centre. The KLIC score assesses factors such as chronic kidney failure (2 points) (Kidney), liver disease (1.5 points) (Liver), revision surgery or femoral neck fracture (1.5 points)and cemented prosthesis (2 points) (Index surgery) and a C-reactive protein level (CRP) greater than 11.5 mg/dL (2.5 points), as a predictor of treatment success or failure in patients with knee and hip acute prosthetic joint infections (APJI).
We retrospectively reviewed 30 patients with APJI who were treated using debridement, antibiotics, irrigation and retention (DAIR) treatment between January 2007 and December 2016. Patients' KLIC scores were calculated. The main outcome was success or failure of DAIR treatment of APJI.
DAIR treatment succeeded in 21 cases and failed in nine cases. Differences in outcome were found according to the KLIC score. For KLIC scores >2 and ≤4, there were three successes and zero failures; for scores 4-5, there were nine successes and two failures; for scores >5 and ≤7,there were nine successes and four failures; and for scores >7, there were zero successes and three failures (p = 0.025). We found a positive predictive value and negative predictive value of 33% and 100% for scores ≤4 (score for calculations: 3.5), 43% and 84% for scores 4-5 (4.5), 50% and 68% for scores >5 and ≤7 (5.5), and 100% and 76% for scores >7 (7.5), respectively. The area under the ROC curve was 0.762 (95% confidence interval, 0.569-0.955).
The KLIC score was useful in predicting success or failure of DAIR treatment of APJI. This supports the conclusion that with a score < 3.5, treatment is likely to succeed and with a score of >6, it is likely to fail.
本研究旨在验证KLIC评分作为膝关节和髋关节急性人工关节感染（APJI）患者治疗成功或失败预测指标的实用性。这些患者在我们中心接受治疗，我们中心并非人工关节感染参考中心。KLIC评分评估慢性肾衰竭（2分）（肾脏）、肝病（1.5分）（肝脏）、翻修手术或股骨颈骨折（1.5分）以及骨水泥假体（2分）（初次手术）等因素，以及C反应蛋白水平（CRP）大于11.5mg/dL（2.5分），作为膝关节和髋关节急性人工关节感染（APJI）患者治疗成功或失败的预测指标。
我们回顾性分析了2007年1月至2016年12月期间30例接受清创、抗生素、冲洗和保留（DAIR）治疗的APJI患者。计算患者的KLIC评分。主要结局是DAIR治疗APJI的成功或失败。
DAIR治疗成功21例，失败9例。根据KLIC评分发现结局存在差异。对于KLIC评分>2且≤4，有3例成功，0例失败；对于评分4 - 5，有9例成功，2例失败；对于评分>5且≤7，有9例成功，4例失败；对于评分>7，有0例成功，3例失败（p = 0.025）。我们发现评分≤4（计算得分：3.5）时的阳性预测值和阴性预测值分别为33%和100%，评分4 - 5（4.5）时为43%和84%，评分>5且≤7（5.5）时为50%和68%，评分>7（7.5）时为100%和76%。ROC曲线下面积为0.762（95%置信区间，0.569 - 0.955）。
KLIC评分有助于预测DAIR治疗APJI的成功或失败。这支持了以下结论：评分<3.5时，治疗可能成功；评分>6时，治疗可能失败。
