Xiong Tuotuo, Qin Wanyuan, Zhang Ye, Chen Yuxing, Ou Yunsheng
Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine, Chongqing, China.
PLoS One. 2024 Dec 13;19(12):e0309267. doi: 10.1371/journal.pone.0309267. eCollection 2024.
This study aimed to evaluate and compare the clinical predictive value of prognostic nutritional index (PNI) and naples prognostic score (NPS) as biomarkers for the prognosis of incisional wound healing in patients who underwent thoracolumbar tuberculosis surgery through the posterior approach.
From January 2019 to October 2021, a total of 124 patients with thoracolumbar tuberculosis who underwent posterior approach debridement and internal fixation were included in this study. We retrospectively analyzed the clinical data, including PNI and NPS. They were divided into poor wound healing (PWH) and non-PWH groups according to whether PWH developed after the operation. And according to the receiver operating characteristic curve, patients were divided into two groups through the threshold value. Risk factors were found using logistic regression analysis.
The unfavorable outcome group had lower hemoglobin, serum albumin, Pre-albumin, PNI, and higher estimated blood loss, instrumented segments, neutrophil count, and NPS (P < 0.05). Both PNI and NPS were strongly correlated with PWH (r = 0.373, P < 0.05; r = -0.306, P < 0.05, respectively). The area under the curve (AUC) of PNI for predicting unfavorable outcomes was 0.764 (95% CI 0.662-0.865, P < 0.001), which was similar to NPS (0.808, 95% CI: 0.719-0.897, P < 0.001). Multivariate stepwise logistic regression analysis showed that PNI, NPS, the neutrophil count, the level of serum albumin, and the number of instrumented segments were independent risk factors for PWH.
Both PNI and NPS might be novel independent biomarkers and predictors of poor outcomes in incisional wound healing after STB surgery.
本研究旨在评估和比较预后营养指数（PNI）和那不勒斯预后评分（NPS）作为生物标志物对经后路行胸腰椎结核手术患者切口愈合预后的临床预测价值。
2019年1月至2021年10月，本研究共纳入124例行后路清创及内固定术的胸腰椎结核患者。我们回顾性分析了包括PNI和NPS在内的临床资料。根据术后是否发生切口愈合不良（PWH）将患者分为PWH组和非PWH组。并根据受试者工作特征曲线，通过阈值将患者分为两组。采用逻辑回归分析寻找危险因素。
不良结局组的血红蛋白、血清白蛋白、前白蛋白、PNI较低，估计失血量、固定节段数、中性粒细胞计数和NPS较高（P<0.05）。PNI和NPS均与PWH密切相关（r分别为0.373，P<0.05；r为-0.306，P<0.05）。PNI预测不良结局的曲线下面积（AUC）为0.764（95%CI 0.662-0.865，P<0.001），与NPS相似（0.808，95%CI：0.719-0.897，P<0.001）。多因素逐步逻辑回归分析显示，PNI、NPS、中性粒细胞计数、血清白蛋白水平和固定节段数是PWH的独立危险因素。
PNI和NPS可能是胸腰椎结核手术后切口愈合不良结局的新型独立生物标志物和预测指标。
