| Background:A combination of anti-tuberculosis drug therapy and surgical treatment is the current gold standard in the treatment of spinal tuberculosis.Among the surgical treatments,lesion debridement surgery is a crucial step that helps to better control the TB lesions.However,spinal tuberculosis lesion removal surgery has many disadvantages,such as high trauma,long operation time and high bleeding,and patients with spinal tuberculosis are significantly more likely to develop postoperative hypoproteinemia than patients with degenerative spinal disease.Objective:The purpose of this study was to analyze the risk factors for the development of hypoproteinemia 3 days after surgery for thoracolumbar spinal tuberculosis and the correlation of early changes in serum albumin levels and to identify independent risk factors.Also,a recommended reference value for preoperative serum albumin level was obtained to provide a theoretical basis for the clinical prevention and treatment of early hypoproteinemia after thoracolumbar spinal tuberculosis surgery.Methods:A retrospective analysis of 178 patients with thoracic or lumbar spine tuberculosis who underwent surgical treatment from December 2015 to October 2022 in our hospital was performed,and after excluding 57 samples that did not meet the criteria,121 cases finally met the inclusion criteria and included in this study.Patients included in the study were divided into hypoproteinemic and no-hypoproteinemic groups based on their mean serum albumin level within 3 days after surgery,and a serum albumin level below 35 g/L was usually used as a criterion for the diagnosis of hypoproteinemia.Clinical data were collected from patients,including but not limited to gender,age,weight,body mass index(BMI),history of diabetes mellitus and hypertension,history of tuberculosis,history of anti-tuberculosis drug use,smoking status,alcohol consumption,disease duration,surgical segment distribution,intraoperative bleeding,operation time,hospitalization time,preoperative hemoglobin value,preoperative total serum protein value,and preoperative serum albumin value.The above clinical characteristics and laboratory indexes were included in the statistical analysis,and when the P value was less than 0.05,the difference was statistically significant.Single-factor dichotomous logistic regression analysis was used to determine the risk factors for the occurrence of early postoperative hypoproteinemia in patients with thoracic and lumbar spinal tuberculosis,and then the above risk factors were subjected to multi-factor dichotomous logistic regression analysis to further determine the postoperative The independent risk factors for the occurrence of early hypoproteinemia in patients with thoracic and lumbar spinal tuberculosis were further determined by multifactorial dichotomous logistic regression analysis of the above risk factors,and the subject work characteristic curves(ROC)were also drawn to determine the minimum recommended values of preoperative serum albumin levels,and the correlation between the magnitude of serum albumin reduction and preoperative serum albumin levels was determined according to the optimal cut-off values.Results:A total of 121 patients with tuberculosis of the thoracic or lumbar spine were included in the study,including 64 male patients and 57 female patients,with an age range of 32-72 years and a mean age of(59.55±11.70)years.There were 97 patients in the hypoproteinemia group,including 49 male patients and 48 female patients with a mean age of(60.03±12.24)years,and 24 patients in the no hypoproteinemia group,15 males and 9 females with a mean age of(57.58±9.17)years.The mean weight of patients in the hypoproteinemia group was(64.67±3.99)Kg,and the mean weight of patients in the no-hypoproteinemia group was(65.58±2.72)Kg.The mean BMI of patients in the hypoproteinemia group was(22.92±1.72)Kg/m~2,and the mean BMI of patients in the no-hypoproteinemia group was(23.90±1.26)Kg/m~2.there was no significant difference between the two groups in terms of gender,age,and weight,but there was a statistically significant difference in BMI.The mean duration of disease in the 121 patients with thoracolumbar spinal tuberculosis included was 6.37 months,with a median of 5 months;the overall distribution of patients’surgical segments was 40 single-segment,47 two-segment,and 34 three-segment;the differences between the two groups in terms of surgical segments>two-segment,operative time,and intraoperative bleeding did not reach statistical significance.The difference in preoperative hemoglobin level between the two groups was not statistically significant in patients with postoperative hypoproteinemia(P=0.858);the preoperative total protein level was(64.29±5.11)g/L in the hypoproteinemia group and(71.98±8.43)g/L in the group without hypoproteinemia,and the difference between the two groups was statistically significant(P<0.001);the preoperative serum albumin level of patients in the hypoproteinemia group was(33.54±3.60)g/L,while the serum albumin level of patients in the no hypoproteinemia group was(41.29±2.82)g/L,and the difference between the two groups was statistically significant(P<0.001).Among the 97 patients with early postoperative hypoproteinemia included,21 patients had preoperative combined diabetes mellitus,while among the 24 patients without hypoproteinemia,6 patients had preoperative combined diabetes mellitus,and there was no statistically significant difference between these two groups(P=0.794).In addition,among the 97 patients with postoperative hypoproteinemia,15 patients had preoperative combined hypertension,while among the 24 patients without hypoproteinemia,5 patients had preoperative combined hypertension,and there was also no statistically significant difference between these two groups(P=0.766);while the two groups had a history of preoperative combined tuberculosis in 45 and 3 patients,respectively,with statistically significant differences(P=0.035).There were 62 and 5 patients with a history of antituberculosis drug administration in the two groups,respectively,and the difference was also statistically significant(P=0.034).The length of hospital stay was(19.69±9.02)days in the hypoproteinemia group and(13.29±7.75)days in the no hypoproteinemia group,with statistically significant differences between the two groups(P=0.001);in addition,there was no statistically significant difference between the two groups in terms of smoking and alcohol consumption.After univariate binary logistic regression analysis of the above clinical characteristics and laboratory indices,it was found that patients with reduced BMI(P=0.013),history of tuberculosis(P=0.006),history of anti-tuberculosis medication(P<0.001,)reduced preoperative serum total protein level(P<0.001)and reduced preoperative serum albumin level(P<0.001)were the most common causes of thoracic Multi-factor binary logistic regression analysis revealed that patients’combined history of tuberculosis(P=0.044),history of anti-tuberculosis medication(P=0.016)and decreased preoperative serum albumin level(P=0.001)were independent risk factors for early postoperative hypoproteinemia in patients with lumbar spine tuberculosis.The maximum Uden index of the ROC curve for preoperative serum albumin level was 0.835,which corresponded to a preoperative serum albumin level of 36.7g/L,suggesting that patients with thoracolumbar spinal tuberculosis had a high risk of early postoperative hypoproteinemia with a preoperative serum albumin level less than 36.7g/L.Patients were divided into preoperative high-risk group and preoperative low-risk group for hypoproteinemia according to the optimal cut-off value of serum albumin.The patients were divided into preoperative high-risk group and preoperative low-risk group according to the optimal cut-off value of serum albumin,and the decrease in serum albumin was(2.63±1.29)g/L in the preoperative high-risk group and(8.07±4.26)g/L in the preoperative low-risk group,and the difference between the two groups was statistically significant(P<0.001).Conclusion:In conclusion,by summarizing and analyzing the clinical features and laboratory indexes related to the occurrence of hypoproteinemia in patients with thoracic and lumbar spine tuberculosis in the early postoperative period,we found that a history of combined pulmonary tuberculosis,a history of anti-tuberculosis drug administration and a decreased preoperative serum albumin level in patients with thoracic and lumbar spine tuberculosis were independent risk factors for the occurrence of hypoproteinemia in the early postoperative period.Preoperative serum albumin levels should be at least 36.7 g/L in patients with thoracolumbar spine tuberculosis to effectively prevent the occurrence of postoperative hypoproteinemia.Therefore,spine surgeons should pay attention to the preoperative clinical features and nutritional status of patients with thoracolumbar TB and actively intervene preoperatively in patients with preoperative low serum albumin levels and a history of combined pulmonary TB and antituberculosis drug use to reduce the incidence of postoperative hypoproteinemia and other related complications and to facilitate the recovery process.In addition,spine surgeons should also monitor and intervene in the nutritional status of postoperative patients to help them recover more quickly. |
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