Xu Xiaopei, Wang Hanzhou, Liu Yang, Wang Dong, Diao Shuo, Gao Yuling, Zhou Junlin
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
Int J Gen Med. 2023 Aug 8;16:3363-3371. doi: 10.2147/IJGM.S426608. eCollection 2023.
The aim of this study is to evaluate the diagnostic accuracy of infection-related biomarkers in high-risk lower limb injury patients with fracture-related infection (FRI) caused by high-/low-virulence microorganisms.
This study was a retrospective analysis of patients with high-risk lower extremity fractures (including tibial plateau, calcaneus, and Pilon fractures) who underwent open reduction internal fixation (ORIF) surgery from January 2017 to February 2022. Peripheral blood samples were collected within 24 hours of admission, and the following information was evaluated: gender, age, BMI, smoking, comorbidities, injury information, surgical details, values for serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), as well as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR).
A total of 576 patients receiving lower extremity fracture surgery were included in this study. Fifty-one patients (8.85%) were identified as FRI, and 28 (54.9%) of these 51 cases were further classified as high-virulence group. The median levels of CRP, ESR, NLR, and MLR were significantly higher in the FRI group than in the non-FRI group (p < 0.01). Similarly, the marginally significantly higher levels of CRP and NLR presented in the high-virulence group, compared to the low-virulence group (p < 0.1). The AUC areas of CRP, NLR, and CRP+NLR were 0.826, 0.650, and 0.873, respectively. We calculated the optimal cut-off points for CRP+NLR as diagnostic markers of high-virulent infection was 0.377.
This study showed the incidence of FRI in high-risk lower extremity fractures was 8.9%, and identified preoperative serum biomarkers, including CRP, ESR, NLR, and PLR, as useful tools for assisting in the diagnosis of infection. Additionally, the combination of CRP with NLR played a discriminating clinical role in postoperative infections caused by different virulence.
Clinical study.
本研究旨在评估感染相关生物标志物对高/低毒力微生物引起的骨折相关感染（FRI）的高危下肢损伤患者的诊断准确性。
本研究是一项回顾性分析，研究对象为2017年1月至2022年2月期间接受切开复位内固定（ORIF）手术的高危下肢骨折患者（包括胫骨平台骨折、跟骨骨折和Pilon骨折）。入院后24小时内采集外周血样本，并评估以下信息：性别、年龄、体重指数、吸烟情况、合并症、损伤信息、手术细节、血清C反应蛋白（CRP）、红细胞沉降率（ESR）以及中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）和血小板与淋巴细胞比值（PLR）。
本研究共纳入576例接受下肢骨折手术的患者。51例患者（8.85%）被确诊为FRI，这51例患者中有28例（54.9%）被进一步归类为高毒力组。FRI组的CRP、ESR、NLR和MLR的中位数水平显著高于非FRI组（p<0.01）。同样，与低毒力组相比，高毒力组的CRP和NLR水平略高（p<0.1）。CRP、NLR和CRP+NLR的AUC面积分别为0.826、0.650和0.873。我们计算出CRP+NLR作为高毒力感染诊断标志物的最佳截断点为0.377。
本研究表明高危下肢骨折患者中FRI的发生率为8.9%，并确定术前血清生物标志物，包括CRP、ESR、NLR和PLR，是协助诊断感染的有用工具。此外，CRP与NLR的联合在不同毒力引起的术后感染中发挥了鉴别临床作用。
临床研究。
