| Objective:Posterior lumbar surgery is one of the most extensive operations in spine surgery.Surgical site infection(SSI)is one of the most common complications in spinal surgery.The aim of this study was to compare the reliability of C-reactive protein(CRP),procalcitonin(PCT),Interleukin 6(IL-6)in predicting SSI after lumbar surgery.the kinetic of CRP PCT IL-6 were assessed in all patients,then analyzing the prognostic value of there biomarkers in these patients.Methods:this study was a retrospective study.27 patients who undergone posterior lumbar surgery in JingZhou central hospital from June 2012 to June 2019 were selected,including 14 patients(SSI group)who were clinically confirmed to have developed deep site infection,and 13 patients(NON-SSI group)serum CRP,PCT and IL-6 were detected after surgery.Inclusion criteria:(1)patients who had complete medical records;(2)patients who had serum CRP,PCT and IL-6 detected between pre-operative,post-operative 1 day,post-operative 3?5 day post-operative 6?8 day;(3)use cephalosporin and glucocorticoid for 3 days after surgery.(4).patients who undergone non-infectious disease.The diagnosis for SSI was refer to guideline for prevention of surgical site infection by CDC in 1999:(1)deep incisional SSI infection occurs within 30 days after the operation or within 1 year if implant is in place and(2)infection involves deep soft tissues and at least one of the following:1.Purulent drainage from the deep incision 2.A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms:fever(>38?),localized pain,or tenderness,unless site is culture-negative.3.An abscess or other evidence of infection involving the deep incision is found on direct examination,during reoperation,or by histopathologic or radiologic examination.4.Diagnosis of a deep incisional SSI by a surgeon or attending physician.All medical records were collected by HIS system.Results:staphylococcus aureus was the main pathogen in the SSI group.CRP PCT IL-6 were significantly increased in all patients between pre-operative and post-operative.The average CRP for SSI group were significantly higher than NON-SSI group on post-operative day3?5 and day6?8 are 47.40 mg/L±15.10:28.97±4.69 mg/L;52.50±13.50 mg/L:21.12±4.48 mg/L(P?0.01).The AUC of CRP is 0.742 on post-operative day3?5 with a sensitivity of 76.9%,specificity of 78.6%.The average PCT for SSI group were significantly higher than NON-SSI group on post-operative day1,day3?5 and day6?8 are1.55±0.52?g/L:0.95±0.23 ?g/L;2.01±0.62?g/L:0.91±0.52?g/L;3.72±1.94?g/L:0.69±0.51?g/L(P?0.01).The AUC of PCT is 0.843 on post-operative day3?5 with a sensitivity of 76.92%,specificity of 92.86%.The average IL-6 for SSI group were significantly higher than NON-SSI group on post-operative day1,day3?5 and day6?8 are 126.46±65.52 pg/mL:37.62±21.29 pg/mL;148.15±59.21pg/mL:62.38±38.51pg/mL;199.14±62.39pg/mL:25.07±8.87pg/mL(P?0.01).The AUC of PCT is 0.843 on post-operative day3?5 with a sensitivity of 92.3%,specificity of 74.3%.The sensitivity and specificity in combined detection of CRP PCT IL-6 were all improved compared with that of the single detection.The AUG,sensitivity and specificity of the combined detection on post-operative day3?5 were 0.956,92.3%and 92.9%,100%,100%on post-operative day6?8.Conclusion:1.The levels of serum CRP,PCT and IL-6 could predict the occurrence of SSI after lumbar surgery.serial measurement could help evaluating SSI.2.The sensitivity and specificity of CRP,PCT and IL-6 increased between post-operative day3?5 and day6?8,and may serve as a useful tool for the evaluating SSI at the post-operative day3?5.3.combined detection of the levels of serum CRP,PCT and IL-6 could improve the specificity and sensitivity. |
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