Combined Detection Of CRP And Serum ChE In The Secondary Operation Time Of Damage Control Orthopedics

ObjectiveThe high lethality and disability rate of severe polytrauma are puzzles which orthopedist would face in clinically. With develop of damage control orthopedic, the lethality rate of polytrauma has effectively reducing. Dozens of studies have been done in first-aid measures of damage control, but the timing of secondary surgery of patients with polytrauma has always been in dispute after damage control treatment now. The purpose of this study is to find an ideal inflammatory marker which can reflect the preoperative systemic inflammation level in patients in a timely manner, then to help the orthopedist to determine the appropriate timing of secondary surgery, and reduce the incidence of postoperative infection. And that the indicators are accurate, convenient and effective to meet the basic clinical needs.MethodsNinety-eight cases of severe polytrauma admitted in our department from September 2008 to March 2010 were in this retrospective study. The preoperative inflammatory markers (WBC count, ESR, CRP, ChE) and the postoperative infection were recorded. Statistics analysis was performed with SPSS13.0 software for windows. Correlation test was analyzed by Logistic regression analysis. Then the relationships between serum ChE and CRP, were analyzed by Pearson correlation analysis. The optimal cut-off value of serum ChE and CRP was determined by receiver operating characteristic curve and the postoperative inflammatory state and outcome were compared according to the cut-off value grouping.ResultC-reactive protein and serum ChE had a significant correlation with postoperative infection(P<0.05)while WBC and ESR did not have(P>0.05). And CRP was negatively correlated with ChE. Make the largest point of the Youden index (sensitivity+specificity-1) as the optimal cut-off value of receiver operating characteristic (ROC) curve. the optimal cut-off value of preoperative CRP was 45 mg/L, and areas under the curve were 0.901, Significantly greater than 0.5. At this point, calculated from: sensitivity of 93.75% and specificity was 73.17%,26.83% false positive rate, false negative rate was 6.25%,40.54% positive predictive value, negative predictive value 98.36%,76.53% accuracy. The optimal cut-off value of preoperative ChE was 3600 U/L, At this point, calculated from: sensitivity of 100% and specificity was 70.73%,29.27% false positive rate, false negative rate of 0,40% positive predictive value, negative predictive value of 100%, accuracy 75.51%. The separate CRP and ChE factor' s specificity and exactness was not good when used in diagnostic test for predicting postoperative infection.But combined detection of them in serial test improved the specificity and exactness.ConclusionThrough this study, the decrease of serum ChE and C-reactive protein in patients with polytrauma is significantly related to infection after secondary operation, and regardless of age, gender and other factors. Combined detection of serum ChE and C-reactive protein, the specificity and accuracy were significantly higher than the single index detection. Therefore, combined detection of serum ChE and C-reactive protein can be an excellent screening test for postoperative infection in patients with polytrauma.