The Predictive Value Of Preoperative CRP/Alb And NLR In The Occurrence Of SIRS After The Middle And Lower Tibia And Fibula Fractures

Objectives:This study aims to explore the significances of preoperative C-reactive protein/albumin（CRP/Alb）ratio and neutrophil to lymphocyte ratio（NLR）in predicting the occurrence of systemic inflammatory response syndrome（SIRS）after the middle and lower tibia and fibula fractures,which provide references for clinical prevention of the occurrence of SIRS after the middle and lower tibia and fibula fractures.Methods:A total of 74 patients receiving surgeries for middle and lower tibia and fibula fractures in the Yanbian University Hospital from 1^st January 2016 to 30^th October 2020 were recruited.Patients with postoperative SIRS were included in the observation group（n=33）,and those without postoperative SIRS were included in the control group（n=41）.Peripheral blood leukocytes,red blood cells,platelets, neutrophils,lymphocytes,albumin and total protein within 24 hours of admission were recorded,and CRP/Alb and NLR were calculated.Diagnostic indicators of postoperative SIRS,the healing status of postoperative incision,clinical data and preoperative inflammation between groups were compared.Independent influencing factors of SIRS after middle and lower tibia and fibula fractures were assessed by the binary logistics regression method.Receiver operating characteristic（ROC）curves were depicted for obtaining cut-off value,area under the curve（AUC）,sensitivity and specificity of the diagnostic potentials of CRP/ALB and NLR in SIRS.Result:1.Clinical data:No significant differences in the age,operation time,and time from injury to operation were found between groups（all P>0.05）.Compared with the control group,patients in the observation group had worse skin healing（P<0.05）.2.NLR,CRP and CRP/Alb in the observation group were significantly higher than those in the control group（all P<0.05）.No significant differences in the white blood cells,red blood cells,hemoglobin,neutrophils,lymphocytes,albumin and platelets were examined between groups（P>0.05）.3.The binary logistics regression results showed that the OR values of CRP/Alb and NLR were 4.170（95%CI,1.272-13.673,P=0.018）and 1.548（95%CI,1.009-2.376,P=0.046）,respectively,which was significant different（P<0.05）.4.ROC curves of CRP/ALB in diagnosing SIRS demonstrated that the AUC,cut-off value,sensitivity and specificity were 0.721（95%CI,P<0.05）,3.1,80%,and 57.5%,respectively.5.ROC curves of NLR in diagnosing SIRS demonstrated that the AUC,cut-off value,sensitivity and specificity were 0.771（95%CI,0.659-0.883,P<0.05）,1.11,56%,and87.5%,respectively.Conclusion:1.The preoperative CRP/Alb ratio and NLR are independent risk factors for SIRS after the middle and lower tibia and fibula fractures,showing good predictive values.2.The preoperative CRP/Alb ratio and NLR are conductive to develop individualized treatment for the middle and lower tibia and fibula fractures,which reduce the postoperative incidence of SIRS as much as possible,thus preventing postoperative complications like skin necrosis and infection.