Department of orthopaedic surgery, Yantai Yuhuangding Hospital, Yantai, China.
Int Wound J. 2023 Jan;20(1):92-99. doi: 10.1111/iwj.13843. Epub 2022 May 17.
Identification of novel markers would contribute to the individualised risk assessment and development of a risk prediction model. This study aimed to investigate the role of the C-reactive protein to albumin ratio (CAR) in predicting surgical site infection (SSI) following instrumented posterior lumbar interbody fusion (PLIF) of lumbar degenerative diseases. This study enrolled patients who underwent PLIF and instrumentation for treatment of lumbar degenerative diseases between 2015 and 2020. Electronic medical records were inquired for data collection, with follow-up register for identifying SSI cases. The optimal cut-off for CAR was determined by constructing the receiver operator characteristic (ROC) curve. Patients with high- or low-CAR value were compared using the univariate analyses, and the association between CAR and the risk of SSI was investigated using multivariate logistics regression analysis. A total of 905 patients were enrolled, twenty-nine (3.2%) had developed an SSI with 72.4% occurring during index hospitalisation, and 11 (1.2%) had deep and 18 (2.0%) superficial SSIs. An SSI was associated with additional 10.7 days of index total hospital stay (P = .001). The CAR was 0-5.43 (median, 0.05), and the optimal cut-off was 0.09 and area under the curve was 0.720 (P < .001). 336 (37.1%) patients had a CAR ≥0.09 and 22 (6.5%) developed an SSI, with a crude risk of 5.6 relative to those with a low CAR. The multivariate analyses showed CAR ≥0.09 was associated with 8.06-fold increased risk of SSI, together with diabetes (P = .018), while hypertension was identified as a protective factor (OR, 0.34; 95%CI, 0.11-1.00, P = .049). High CAR is found to significantly predict the incident SSI following instrumented PLIF of lumbar degenerative diseases, and can be considered as a useful index in practice only after it is verified by future high-level evidences.
新型标志物的鉴定有助于进行个体化风险评估和开发风险预测模型。本研究旨在探讨 C 反应蛋白与白蛋白比值（CAR）在预测腰椎退行性疾病后路经椎间孔腰椎体间融合术（PLIF）内固定术后手术部位感染（SSI）中的作用。本研究纳入了 2015 年至 2020 年间接受 PLIF 和内固定治疗腰椎退行性疾病的患者。通过电子病历查询数据收集，并进行随访登记以确定 SSI 病例。通过构建受试者工作特征（ROC）曲线确定 CAR 的最佳截断值。使用单因素分析比较高或低 CAR 值患者，并使用多因素逻辑回归分析探讨 CAR 与 SSI 风险之间的关系。共纳入 905 例患者，29 例（3.2%）发生 SSI，72.4%发生在住院期间，11 例（1.2%）为深部 SSI，18 例（2.0%）为浅部 SSI。SSI 导致住院总天数额外增加 10.7 天（P=.001）。CAR 为 0-5.43（中位数，0.05），最佳截断值为 0.09，曲线下面积为 0.720（P<.001）。336 例（37.1%）患者 CAR≥0.09，22 例（6.5%）发生 SSI，与低 CAR 患者相比，粗风险为 5.6。多因素分析显示，CAR≥0.09 与 SSI 的风险增加 8.06 倍相关，同时糖尿病（P=.018）也是一个危险因素，而高血压则被认为是一个保护因素（OR，0.34；95%CI，0.11-1.00，P=.049）。高 CAR 显著预测腰椎退行性疾病后路经椎间孔腰椎体间融合术后 SSI 的发生，仅在未来高水平证据验证后，才可考虑将其作为一种有用的指标。
