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完整血清比率预测了整体关节关节整形术后的不良事件
Ian A Jones1, Julian Wier, Matthew S Chen
1From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA (Jones), and the Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Wier, Chen, Liu, Palmer, Mayfield, Heckmann).
手术前的基于全血细胞计数的比率 (CBR) 与中性粒细胞-淋巴细胞比率 (NLR) 一样,预测了手术后的并发症和关节置换手术后的长时间住院. 为这些炎症标志物建立了值.
科学领域:
- 整形外科 整形外科 整形外科
- 炎症生物学 炎症生物学
- 生物标志物研究 生物标志物研究
背景情况:
- 基于全血细胞计数的比率 (CBRs),如中性细胞-淋巴细胞比率 (NLR),单细胞-淋巴细胞比率 (MLR),血小板-淋巴细胞比率 (PLR) 和全身免疫炎症指数 (SII),反映了身体对手术压力的炎症反应.
- 这些炎症标志物越来越多地被认为是主要手术后患者结果的潜在预测因素.
研究的目的:
- 调查手术前的CBR与术后并发症的发生,延长住院时间 (LOS) 和接受全关节整形术 (TJA) 的患者的死亡率之间的关联.
- 确定与不良结果相关的这些CBR的特定值,为未来的研究和临床应用提供基准.
主要方法:
- 进行了Premier Healthcare数据库的回顾性分析,包括接受初级选择性关节整形手术 (THA) 或全膝关节整形手术 (TKA) 的成年患者.
- 使用Youden指数的bootstrap模拟来确定CBR的近似切断点值.
- 用多变量调整的受限制立方线模型来确定与增加研究结果的赔率比率 (aOR) 相关的最终值.
主要成果:
- 这项研究分析了32,868例TJA病例 (12,807例THA,20,061例TKA).
- 所有评估的CBR (NLR,MLR,PLR,SII) 都与THA和TKA患者总体术后并发症风险增加有关 (P<0.05).
- 确定了特定的值:MLR>0.40对于THA后≥3天的LOS (aOR=1.54);NLR>13.1 (aOR=1.38) 和MLR>0.41 (aOR=1.29)对于TKA后≥3天的LOS. 这些标志物与住院患者死亡率之间没有发现显著的关联.
结论:
- 手术前的CBR作为术后并发症和全关节整形术后长期LOS的有价值预测剂.
- 确定的门值为未来的研究提供了基础,研究重点是识别高风险患者.
- 这些发现支持在高风险患者群体中使用免疫调节疗法的可能性,等待临床试验中的进一步验证.
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