Abstract
ObjectiveTo determine the relationship between inflammation/immune-based indexes and deep venous thrombosis (DVT) incidence rate following tibial plateau fracturesMethodsRetrospective analysis of a prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was performed. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on biomarkers (neutrophil, lymphocyte, monocyte, and platelet counts) at admission were collected, based on which neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte/lymphocyte (MLR), and systemic immune-inflammation index (SII, neutrophil* platelet/lymphocyte) were calculated. Receiver operating characteristic (ROC) was used to determine the optimal cutoff value for each variable. Multivariate logistic regression analysis was used to evaluate the independent relationship of each biomarker or index with DVT, after adjustment for demographics, co-morbidities, and injury-related variables.ResultsAmong 1179 patients included, 16.3% (192/1179) of them had a preoperative DVT. Four factors were identified to be significantly associated with DVT, including open fracture, increased D-dimer level. Among the biomarkers and indexes, only platelet and neutrophil were identified to be independently associated with DVT, and the significance remained after exclusion of open fracture. The other independent variables were elevated D-dimer level (> 0.55 mg/L), male gender, and hypertension in the sensitivity analysis with open fractures excluded.ConclusionThese identified factors are conducive to the initial screening for patients at risk of DVT, individualized risk assessment, risk stratification, and accordingly, development of targeted prevention programs.
Highlights
Tibial plateau fracture represented 1–2% of adult fractures and 32% of peri-knee fractures [1], with a populationbased incidence of 10.3 per 100,000 person-years [2]
Researchers have identified the significant correlation of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), or monocyte to lymphocyte ratio (MLR) with acute deep venous thrombosis (DVT) after major orthopedic surgery [12,13,14]
The preoperative Duplex ultrasonography (DUS) was performed at a mean of 3.9 ± 3.6 days after injury, by 5 different technicians
Summary
Tibial plateau fracture represented 1–2% of adult fractures and 32% of peri-knee fractures [1], with a populationbased incidence of 10.3 per 100,000 person-years [2]. It is generally accepted that deep venous thrombosis (DVT) is a significant cause of morbidity, pulmonary embolism, and even mortality, especially in patients with trauma or undergoing major orthopedic surgery [3, 4]. Unlike other markers of inflammation, these indexes are calculated by the readily obtained biomarkers from a hemogram with an automated differential, which are routinely measured. If these inexpensive and readily available indexes exhibit their value in predicting DVT after traumatic fractures, they will help identify patients at risk of DVT and improve the specificity in detection of DVT
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