Diagnosis value of serum infection index for early infection of patients undergoing posterior cervical expansive open-door laminoplasty

Abstract

To investigate the diagnosis value of white blood cell (WBC) count, C-reactive protein (CRP), serum procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) levels for early infection after posterior cervical expansive open-door laminoplasty. Discover, prevent, and treat postoperative infections promptly. The clinical data of 120 patients with early fever after posterior cervical laminoplasty from January 2010 to April 2019 were retrospectively analyzed. According to the results of bacteriological culture of wound exudate, the patients were divided into infected group(53 cases) and non-infected group(67 cases). In infection group, there were 32 males and 21 females, aged from 48 to 63 years old, with an average of(52.28±6.36) years. In non-infected group, there were 37 males and 30 females, aged from 46 to 62 years old, with an average of(51.63±5.82) years. According to the postoperative infection types, the patients in infection group were divided into 30 cases of deep surgical site infection group and 23 cases of superficial surgical site infection group. In deep surgical site infection group, there were 19 males and 11 females, aged from 50 to 63 years old with an average of (53.16±5.62) years. In superficial surgical site infection group, there were 13 males and 10 females, aged from 48 to 61 years old with an average of (52.15±5.68) years. WBC count, CRP, PCT and ESR serum infection indexes were compared between groups and within groups before and after surgery. The serum infective index data of 120 patients were collected and the sensitivity and specificity of the serum infectious index were used to diagnose the infection. Accuracy assessment of early infection diagnosis of WBC count, CRP, PCT and ESR serum infection indexes by plotting the receiver operating characteristic(ROC) curve with 1-specificity as the abscissa and sensitivity as the ordinate. There were no significant difference in WBC count, CRP, PCT and ESR serum infection indexes between infected group and non-infected group before operation(P>0.05). Postoperative WBC count, CRP, PCT and ESR infection indexes in infection group were higher than in non-infected group(P<0.05). Among patients with postoperative infection, WBC count, CRP, PCT and ESR serum infection index levels were significantly different in the different postoperative infection types (P<0.05). In non-infected group, WBC count, CRP, PCT and ESR serum infection indexes showed an overall trend of rising first and then falling. The area under curve (AUC) of WBC count infection index was 0.637(P<0.05). The AUC of CRP infection index was 0.792 (P<0.05). The AUC of PCT infection index was 0.774 (P<0.05). The AUC of ESR infection index was 0.783(P<0.05). WBC count, CRP, PCT and ESR serum infection indexes can be used for the diagnosis of early infection after posterior cervical expansive open-door laminoplasty. In addition, the comprehensive analysis of the changes of the four infection indexes can be used for the identification of different postoperative infection types. WBC count index is less accurate for early infection diagnosis, and CRP, PCT, and ESR indexes are more accurate for early infection diagnosis. In general, CRP, PCT and ESR serum infection indexes have important clinical significance for the diagnosis of early infection after posterior cervical open-door laminoplasty, which helps clinicians to detect early postoperative infection as early as possible to facilitate subsequent treatment.