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Systemic Inflammatory Response Syndrome and Prosthetic Joint Infection
Zachary A McConnell1, Karan M Patel1, Simon C Mears1
1Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
The Journal of Arthroplasty
|August 2, 2023
Summary
Systemic inflammatory response syndrome (SIRS) affects nearly 10% of prosthetic joint infection (PJI) patients, leading to longer hospital stays and higher mortality. Identifying risk factors like anemia and diabetes can help manage PJI patients with SIRS.
Area of Science:
- Orthopedics
- Infectious Diseases
- Critical Care Medicine
Background:
- Systemic inflammatory response syndrome (SIRS) criteria are associated with increased mortality.
- The development and impact of SIRS in patients with prosthetic joint infection (PJI) are not well understood.
Purpose of the Study:
- To determine the incidence of SIRS in patients with PJI.
- To identify risk factors, clinical outcomes, and causative organisms in PJI patients who develop SIRS.
Main Methods:
- Retrospective analysis of 655 patients with hip or knee PJI.
- Comparison between patients with SIRS alert (PJI + SIRS) and without (PJI).
- Analysis of clinical outcomes, comorbidities, and microbiological data.
Main Results:
- SIRS developed in 9.6% of PJI patients.
- PJI + SIRS was associated with higher ICU admission (27.0% vs 6.9%), longer hospital stays (7.7 vs 5.6 days), and increased 2-year reoperation (36.5% vs 22.3%) and mortality rates (17.5% vs 8.8%).
- Risk factors included various anemias, diabetes, electrolyte and neurological disorders, renal failure, and peptic ulcer disease. Staphylococcus aureus was more common in PJI + SIRS.
Conclusions:
- SIRS incidence is approximately 10% in PJI patients.
- PJI + SIRS significantly increases adverse outcomes, including length of stay, ICU admission, reoperation, and mortality.
- Certain comorbidities can help stratify the risk of developing SIRS in PJI patients.
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