Yiğit Ş, Akar M S
Department of Orthopaedic Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(5):1869-1874. doi: 10.26355/eurrev_202303_31551.
There are no gold standard markers to estimate the risk of developing periprosthetic infections in diabetes mellitus. Our aim is to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus and to investigate the predictive significance of the HbA1c/ albumin ratio.
Between January 2012 and January 2020, 690 patients who underwent total joint arthroplasty were analysed. 264 diabetic patients were included in the study. 104 of them had periprosthetic infection. 8 risk factors (Hba1c/albumin, HbA1c, albumin, age, BMI, ASA, hospital stay, operation time) were analysed.
The rate of HbA1c/albumin was 14.6 times higher than the patients with ≤2.37 cut-off value. (Hba1c/albumin ratio (odds ratio (OR) = 14.6, 95% CI: 3.18-67.1, p: 0.01). HbA1c (OR = 2.6, 95% CI: 1.529-4.754, p: 0.001), BMI (OR = 1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR = 0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR = 1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR = 0.503, 95% CI: 0.109-2.314, p: 0.378) did not pose a significant risk for periprosthetic infection.
According to our findings, the HbA1c/albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. HbA1c/albumin ratio is a cheap and easy-to-apply marker. Patients with an HbA1c/albumin cut-off ratio above 2.37 mg/dl in total joint arthroplasty should be followed more closely for the risk of periprosthetic infection.
目前尚无评估糖尿病患者发生假体周围感染风险的金标准标志物。我们的目的是比较接受全关节置换术的糖尿病患者发生假体周围感染的风险，并研究糖化血红蛋白/白蛋白比值的预测意义。
对2012年1月至2020年1月期间接受全关节置换术的690例患者进行分析。本研究纳入了264例糖尿病患者。其中104例发生了假体周围感染。分析了8个危险因素（糖化血红蛋白/白蛋白、糖化血红蛋白、白蛋白、年龄、体重指数、美国麻醉医师协会分级、住院时间、手术时间）。
糖化血红蛋白/白蛋白比值高于截断值≤2.37的患者14.6倍。（糖化血红蛋白/白蛋白比值（比值比（OR）=14.6，95%可信区间：3.18 - 67.1，p：0.01）。糖化血红蛋白（OR = 2.6，95%可信区间：1.529 - 4.754，p：0.001）、体重指数（OR = 1.6，95%可信区间：1.168 - 2.199，p<0.003）、糖尿病（OR = 0.365，95%可信区间：0.135 - 0.987，p：0.04）和血糖（OR = 1.016，95%可信区间：1.004 - 1.029，p：0.011）是假体周围感染的危险因素。白蛋白（OR = 0.503，95%可信区间：0.109 - 2.314，p：0.378）对假体周围感染无显著风险。
根据我们的研究结果，在确定全关节置换术假体周围感染风险方面，糖化血红蛋白/白蛋白比值比其他危险因素具有更强的预后评估能力。糖化血红蛋白/白蛋白比值是一种廉价且易于应用的标志物。全关节置换术中糖化血红蛋白/白蛋白截断比值高于2.37 mg/dl的患者应更密切地随访假体周围感染风险。
