Duan Zehua, Sun Shilong, Qu Cheng, Wang Kai, Chen Fang, Wang Xinyu, Chu Chengnan, Liu Baochen, Li Jieshou, Ding Weiwei
Division of Trauma and Surgical Intensive Care Unit, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
School of Medicine, Southeast University, Nanjing, China.
Ann Transl Med. 2021 Sep;9(17):1373. doi: 10.21037/atm-21-1078.
Deep surgical site infections (DSSIs) are serious complications after laparotomy. Neutrophil extracellular traps (NETs) play a vital role in the development of DSSI. Here, we focused on a new approach to predicting the occurrence of DSSI through the detection of the NET formation index (NFI), and compared its prediction ability with other clinical infection indicators.
Patients who received laparotomy were prospectively enrolled in this study. General information, APACHE II score, SOFA score, and serum infection indicators were recorded. The postoperative abdominal drainage fluid was collected within 3 days after the operation for quantification of the NFI.
A total of 92 consecutive patients were included, with 22 patients were diagnosed with DSSI. The NFI in the DSSI group was 32.70%±19.33% while the corresponding index was 10.70%±8.25% in the non-DSSI group (P<0.01). The mean APACHE II and SOFA score had significant differences between the two groups. The NFI was positively correlated with the APACHE II score (P<0.01, r=0.269) and SOFA score (P=0.013, r=0.258). Patients with a high NFI (NFI >13.86%) had a higher risk of developing DSSI. According to the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC) of the NFI, C-reactive protein (CRP) and procalcitonin (PCT) were 0.912, 0.748 and 0.731, respectively.
In this cohort of surgical patients, the quantification of the NFI had a considerable predictive value for early identification of DSSI. The NFI in drainage fluid turned out to be a more sensitive and specific predictor of DSSI than serum infection indicators including CRP and PCT.
深部手术部位感染（DSSIs）是剖腹手术后的严重并发症。中性粒细胞胞外陷阱（NETs）在DSSI的发生发展中起重要作用。在此，我们着重探讨一种通过检测NET形成指数（NFI）来预测DSSI发生的新方法，并将其预测能力与其他临床感染指标进行比较。
前瞻性纳入接受剖腹手术的患者。记录一般信息、急性生理与慢性健康状况评分系统II（APACHE II）评分、序贯器官衰竭评估（SOFA）评分及血清感染指标。术后3天内收集腹腔引流液以定量NFI。
共纳入92例连续患者，其中22例被诊断为DSSI。DSSI组的NFI为32.70%±19.33%，而非DSSI组相应指数为10.70%±8.25%（P<0.01）。两组间APACHE II和SOFA评分均值有显著差异。NFI与APACHE II评分呈正相关（P<0.01，r=0.269），与SOFA评分呈正相关（P=0.013，r=0.258）。NFI高（NFI>13.86%）的患者发生DSSI的风险更高。根据受试者工作特征（ROC）曲线，NFI、C反应蛋白（CRP）和降钙素原（PCT）的ROC曲线下面积（AUC）分别为0.912、0.748和0.731。
在该组手术患者中，NFI定量对早期识别DSSI具有相当的预测价值。腹腔引流液中的NFI被证明是比包括CRP和PCT在内的血清感染指标更敏感、特异的DSSI预测指标。
