Preoperative Erythrocyte Sedimentation Rate Research Articles

Superinfections of the Spine: A Single-Institution Experience.

Background/Objectives: A superinfection occurs when a new, secondary organism colonizes an existing infection. Spine infections are associated with high patient morbidity and sometimes require multiple irrigations and debridements (I&Ds). When multiple I&Ds are required, the risk of complications increases. The purpose of this study was to report our experience with spine superinfections and determine which patients are typically affected. Methods: A retrospective case series of spine superinfections and a retrospective case-control analysis were conducted. Data were collected manually from electronic medical records. Spine I&Ds were identified. Groups were created for patients who had multiple I&Ds for (1) a recurrence of the same causative organism or (2) a superinfection with a novel organism. Preoperative demographic, clinical, and microbiologic data were compared between these two outcomes. A case series of superinfections with descriptive data was constructed. Lastly, two illustrative cases were provided in a narrative format. Results: A total of 92 patients were included in this analysis. Superinfections occurred after 6 out of the 92 (7%) initial I&Ds and were responsible for 6 out of the 24 (25%) repeat I&Ds. The preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the patients with a superinfection were significantly lower than those in the control group (p = 0.022 and p = 0.032). Otherwise, the observed differences in the preoperative variables were not statistically different. In the six cases of superinfection, the presence of high-risk comorbidities, a history of substance abuse, or a lack of social support were commonly observed. The superinfecting organisms included Candida, Pseudomonas, Serratia, Klebsiella, Enterobacter, and Staphylococcus species. Conclusions: Superinfections are a devastating complication requiring reoperation after initial spine I&D. Awareness of the possibility of superinfection and common patient archetypes can be helpful for clinicians and care teams. Future work is needed to examine how to identify, help predict, and prevent spine superinfections.

Preoperative laboratory measurements as a predictor for nasal steroid irrigations after sinus surgery for chronic rhinosinusitis with nasal polyps

PurposeTo assess whether preoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), immunoglobulin E (IgE), and blood eosinophil percentage (EOS) can predict need for steroid irrigations after FESS. Materials and methodsAdult patients at BIDMC from inception until September 8, 2023 with chronic rhinosinusitis with nasal polyps who underwent FESS and had preoperative CRP (n = 129), ESR (n = 79), IgE (n = 107), or EOS (n = 125) were included. Labs were divided into normal (CRP: 0–5.0 mg/L; ESR: 0-15 mm/h; IgE: 150-300Ul/mL; EOS: 1–7 %) and high groups (CRP: >5.0 mg/L; ESR: >15 mm/h; IgE: >300Ul/mL; EOS: >7 %). The primary outcome was need for intranasal steroid irrigations after FESS (≤4 weeks, 4–12 weeks, 12–26 weeks, 26–52 weeks, 1–3 years, 3–5 years, and > 5 years). Receiver operating characteristic curves were created to determine thresholds for predicting postoperative steroid irrigations. ResultsElevated IgE required intranasal steroid irrigation at 1–3 years (normal 34 %, high 62 %, p = 0.02), 3–5 years (normal 24 %, high 48 %, p = 0.04), and > 5 years (normal 19 %, high 43 %, p = 0.02). Elevated EOS required intranasal steroid irrigation at 26–52 weeks (normal 7 %, high 25 %, p = 0.009) and > 5 years (normal 19 %, high 46 %, p = 0.005). The area under the curve for IgE at 1–3 years was 0.696 (95 % CI: 0.597–0.795) with cutoff at 144–148 Ul/mL. CRP and ESR were not predictive of postoperative intranasal steroid treatment. ConclusionsElevated IgE and EOS (but not CRP or ESR) may predict need for intranasal steroid treatment after FESS.

Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis Focus Removal versus Posterior Pedicle Lesion Removal, Bone Grafting, and Internal Fixation Combined with Drug Chemotherapy for Thoracolumbar Tuberculosis.

This study aims to investigate the clinical efficacy of endoscopic spinal tuberculosis focus removal, posterior pedicle lesion removal, bone grafting, and internal fixation combined with drug chemotherapy in treating thoracolumbar tuberculosis. It also seeks to summarize strategies for preventing complications and provide a reference for clinical treatment. We retrospectively analyzed 105 patients with spinal tuberculosis treated in our hospital from January 2018 to December 2022. Patients were divided into two groups: Group A (n=38), who underwent endoscopic spinal tuberculosis focus removal, and Group B (n=67), who underwent posterior pedicle lesion removal, bone grafting, and internal fixation. All patients received preoperative quadruple anti-tuberculosis drug chemotherapy (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) for 2-4 weeks. We recorded and compared parameters such as operation time, intraoperative blood loss, postoperative drainage, recovery time, hospital stay, blood transfusion, and complications. We also compared pre- and postoperative lumbar VAS, ODI, erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, and Cobb angle to evaluate kyphotic deformity and correction. Preoperative data including age, sex, body mass index, segment involvement, past medical history, smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, lumbar VAS score, lumbar ODI score, and spinal Cobb's angle showed no significant difference between the groups (P>0.05). Main postoperative indicators revealed that Group A had significantly lower lumbar VAS scores, higher hemoglobin and total protein levels, and a lower recurrence rate than Group B at the last follow-up (P<0.05). Secondary postoperative indicators showed that Group A required significantly less blood transfusion, had shorter operative time, less intraoperative blood loss, shorter postoperative hospitalization time, and lower Cobb Angle than Group B (P<0.05). Endoscopic spinal tuberculosis focus removal can achieve comparable safety to posterior pedicle lesion removal, bone grafting, and internal fixation, with shorter operation time, less intraoperative bleeding, lower postoperative recurrence rate, and less postoperative drainage. This method can effectively improve blood sedimentation, lumbar function, restore Cobb angle, and reduce pain, making it worthy of promotion and application.

Risk factors associated with postoperative delirium in elderly patients undergoing hip surgery.

We retrospectively analyzed the occurrence of postoperative delirium following hip surgery and the associated risk factors. The aim was to establish a clinical foundation for preventing postoperative delirium after hip surgery. We retrospectively selected elderly patients who had hip surgery at our hospital between January 2022 and August 2022. We included patients who experienced delirium in the observation group and those who did not encounter delirium in the control group. We then proceeded to compare various indicators among these two groups of patients. We analyzed a total of 97 cases of hip surgery, and among them, 32 cases experienced postoperative delirium, resulting in an incidence rate of 32.9%. Various factors were found to be linked to the development of postoperative delirium, including age, height, gender (male), preoperative erythrocyte sedimentation rate (ESR), postoperative ESR, preoperative lactate levels, pain scores on the first day after surgery, type of surgical procedure, and the occurrence of delirium in the post-anesthesia care unit (PACU delirium). Additionally, it was observed that 75% of patients who had PACU delirium also experienced postoperative delirium. Postoperative delirium in patients who have hip surgery had an incidence rate of 32.9%. This phenomenon is linked to various factors that pose a risk, such as the patient age, height, gender, preoperative ESR levels, postoperative ESR levels, preoperative lactate levels, pain scores on the day following surgery, and the specific surgical procedure performed. The likelihood of experiencing delirium increases by 12% for every additional 10 years in patient age. Additionally, the occurrence of delirium in the PACU is a strong indicator of the likelihood of experiencing postoperative delirium.

The Role of Combined Inflammatory Biomarkers in the Diagnosis of High- and Low-Virulence FRI Among High-Risk Lower Extremity Fractures.

The aim of this study is to evaluate the diagnostic accuracy of infection-related biomarkers in high-risk lower limb injury patients with fracture-related infection (FRI) caused by high-/low-virulence microorganisms. This study was a retrospective analysis of patients with high-risk lower extremity fractures (including tibial plateau, calcaneus, and Pilon fractures) who underwent open reduction internal fixation (ORIF) surgery from January 2017 to February 2022. Peripheral blood samples were collected within 24 hours of admission, and the following information was evaluated: gender, age, BMI, smoking, comorbidities, injury information, surgical details, values for serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), as well as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR). A total of 576 patients receiving lower extremity fracture surgery were included in this study. Fifty-one patients (8.85%) were identified as FRI, and 28 (54.9%) of these 51 cases were further classified as high-virulence group. The median levels of CRP, ESR, NLR, and MLR were significantly higher in the FRI group than in the non-FRI group (p < 0.01). Similarly, the marginally significantly higher levels of CRP and NLR presented in the high-virulence group, compared to the low-virulence group (p < 0.1). The AUC areas of CRP, NLR, and CRP+NLR were 0.826, 0.650, and 0.873, respectively. We calculated the optimal cut-off points for CRP+NLR as diagnostic markers of high-virulent infection was 0.377. This study showed the incidence of FRI in high-risk lower extremity fractures was 8.9%, and identified preoperative serum biomarkers, including CRP, ESR, NLR, and PLR, as useful tools for assisting in the diagnosis of infection. Additionally, the combination of CRP with NLR played a discriminating clinical role in postoperative infections caused by different virulence. Clinical study.

Surgical Outcome and Prognosis of Patients with Spinal Metastasis from Esophageal Cancer: The Experience from a Single Center

The spine is one of the common sites of esophageal cancer metastasis, with a worse prognosis than that of metastasis occurring in other sites. However, the exact mechanism underlying metastatic spinal esophageal cancer (MSEC) is poorly understood possibly due to the short survival time of patients. The aim of this study was to evaluate surgical outcomes and factors affecting the prognosis of MSEC patients. Enrolled in this retrospective study were 20 consecutive patients who received surgical treatment for MSEC in our hospital from 2013 to 2020. The impact of surgery on patient's quality of life was assessed by VAS score and ASIA grade. Prognostic variables relative to traditional clinical parameters and inflammation and nutrition indicators were identified by univariate and multivariate analyses. The median survival time of MSEC patients was 6 months, with a one-year survival rate of 20%. Pain relief was achieved in most patients and nerve function was recovered in part of the patients after surgery. Analysis of clinical factors showed that total tumor resection was beneficial to overall survival (OS) of MSEC patients. Laboratory indicators of erythrocyte sedimentation rate (ESR), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were identified as independent prognostic factors for MSEC patients. Timely surgical intervention can improve the quality of life of MSEC patients. The preoperative ESR, NLR and PLR could help predict the OS of MSEC patients. These findings may help decision making for the treatment of MSEC patients.

Long Term Outcomes and Potential Risk Factors for Endovascular Repair of Aortic Pseudoaneurysms in Vascular Behçet’s Disease

This study aimed to analyse long term outcomes and risk factors for endovascular repair of aortic pseudoaneurysms in patients with vascular Behçet's disease (BD). Medical records of 26 aortic vascular BD patients who underwent endovascular treatment at the vascular department of Peking Union Medical College Hospital between January 2002 and December 2021 were reviewed retrospectively. Erythrocyte sedimentation rate (ESR) and C reactive protein were used to assess BD activity. Computed tomography angiography (CTA) was obtained pre- and post-operatively for almost all patients. Univariable logistic regression analysis was used to analyse risk factors for endovascular repair, such as inflammatory indicators, drug usage, and stent graft parameters. The abdominal aorta (n = 17) was the most common site of 27 vascular BD pseudoaneurysms in this study. CTA also revealed one aortic arch pseudoaneurysm, seven descending thoracic aortic pseudoaneurysms, one thoraco-abdominal aortic pseudoaneurysm, and one pseudoaneurysm at the aortic bifurcation. Most of the pseudoaneurysms were treated with covered stent grafts. The technical success rate was 96% and no deaths occurred during hospital stay. The mean follow up was 5.8 ± 5.5 years and 31% (8/26) experienced post-operative complications. Overall one, three, and five year event free survival rates were 87%, 78%, and 74%, respectively. Univariable logistic regression analysis revealed that pre-operative ESR ≥ 16.0 mm/h (p= .040), pre-operative glucocorticoid (GC) use ≤ 11.5 days (p= .024), pre-operative immunosuppressant use ≤ 15.5 days (p= .028), and length of proximal landing zone ≤ 1.95 cm (p= .034) were associated with a worse prognoses following endovascular treatment. Proximal oversize ≥ 9.5% (p= .074) was also regarded as a risk factor, although not statistically significant. This study further confirmed the feasibility of endovascular repair for aortic vascular BD patients. Risk factors predicting poor prognoses included elevated pre-operative ESR, insufficient pre-operative GC use or immunosuppressant use, inadequate proximal landing zone, and larger proximal oversize percentage.

Diagnostic value of preoperative blood parameters in periprosthetic joint infections

Aim: Diagnosis of periprosthetic joint infection (PJI) is not easy and it is made by presenting of combined findings rather than a single finding. The aim of this study is to investigate the role of blood parameters in diagnosing PJI.&#x0D; Material and Method: Revisions of total knee replacement and total hip replacement operated by the same surgeon between 2008 and 2018 were included in this study. Preoperative blood parameters of the patients were recorded. 69 primary arthroplasty patients with similar demographic characteristics to the patients were also included as the control group.&#x0D; Results: 214 arthroplasty patients, 79.0% of whom were female (n=169), were included in this study. The patients were divided into 3 groups; 32.2% were primary arthroplasty, 36.9% were aseptic revision arthroplasty, and 30.8% were septic revision arthroplasty. There was no difference between the three groups in terms of demographic characteristics. In pairwise comparisons, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lymphocyte, and platelet-to-lymphocyte rate (PLR) parameters were found to be significantly different in the septic group when compared to both the aseptic group and the primary arthroplasty group. Further analyzes were performed to evaluate the diagnostic performances of ESR, CRP, lymphocyte, and PLR in PJI relative to aseptic patients by plotting to receive operating characteristic curves.&#x0D; Conclusion: Lymphocyte, PLR, ESR, and CRP may have diagnostic value in predicting PJI. Therefore, these parameters may be helpful in deciding on revision arthroplasty for PJI.

Relationship between survival and erythrocyte sedimentation rate in patients operated for lung cancer.

Background This study aims to investigate the relationship between preoperative erythrocyte sedimentation rate and survival in patients undergoing pulmonary resection due to lung cancer. Methods Between January 2011 and July 2017, a total of 575 patients (433 males, 142 females; mean age: 61.2±9.9 years; range, 29 to 82 years) who were operated due to primary lung cancer in our clinic were retrospectively analyzed. The patients were grouped according to erythrocyte sedimentation rate to analyze the relationship between erythrocyte sedimentation rate and survival. Results The mean overall survival time was 61.8±1.7 months in 393 patients with an erythrocyte sedimentation rate of ≤24 mm/h and 48.9±2.9 months in 182 patients with an erythrocyte sedimentation rate of ≥25 mm/h (p<0.001). Among the patients with Stage 1-2 disease, the mean survival time was 66.2±1.9 in patients with an erythrocyte sedimentation rate of ≤24 mm/h and 53.8±3.2 in patients with an erythrocyte sedimentation rate of ≥25 mm/h (p=0.008). The mean survival time in patients with adenocarcinoma was 62.4±2.4 months in patients with ≤24 mm/h erythrocyte sedimentation rate and 46.1±4.6 months in patients with ≥25 mm/h erythrocyte sedimentation rate (p=0.003). Conclusion The relationship between elevated erythrocyte sedimentation rate and poor prognosis in patients with the same stage of the disease is promising for the use of erythrocyte sedimentation rate as a prognostic marker.

Preoperative erythrocyte sedimentation rate in patients with rheumatoid arthritis predicts deep vein thrombosis following total knee arthroplasty.

To thoroughly evaluate preoperative risk factors for deep venous thrombosis (DVT) in patients with knee rheumatoid arthritis (RA) undergoing unilateral total knee arthroplasty (TKA). Clinical data of 106 patients with knee RA who underwent unilateral TKA from August 2014 to October 2020 were collected. All patients received ultrasonic examination of the veins of both lower extremities on the third day after TKA and were divided into DVT and non-DVT groups. The associations between age, gender, body mass index (BMI), history of diabetes/hypertension, common serum lipid levels, indicators related to coagulation function, blood viscosity, erythrocyte sedimentation rate (ESR) and postoperative DVT were statistically compared and analyzed. ESR was significantly correlated with DVT risk after TKA (OR = 1.844, 95% CI = 1.022-2.981, P = 0.019). Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off point of ESR for predicting DVT was 42 mm/h with a sensitivity of 95.5% and specificity of 66.7%. An increased preoperative ESR value is a risk factor for DVT in patients with knee RA following unilateral TKA. Pre-surgery control of ESR level and prevention of postoperative DVT in these patients are worthy of attention.

Value of Postoperative Serum Albumin to Predict Postoperative Complication Severity in Spinal Tuberculosis.

Background Many complications occur after surgery in patients with spinal tuberculosis (STB); however, the severity varies in different patients. The complications' severity is evaluated from grades I to V by the Clavien–Dindo classification (CDC), and grade V is the most severe. Most complications are mild, and only severe complications are life threatening, and thus, it is important to identify severe complications in patients with STB. The purpose of this study was to identify the risk factors of postoperative complication severity in patients with STB. Methods Between January 2012 and May 2021, a retrospective study included 188 patients that underwent STB debridement surgery. The patients were divided into three groups based on postoperative complication severity. Clinical characteristics measured included age, sex, body mass index (BMI), comorbidities of diabetes mellitus and pulmonary tuberculosis, alcohol use and smoking history, course of disease, preoperative hemoglobin, preoperative serum albumin, preoperative lymphocytes, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), surgical approach, operating time, blood loss during surgery, postoperative hemoglobin, and postoperative serum albumin. The clinical characteristics of patients with STB who developed postoperative complications were evaluated using logistic regression analysis. Results 188 patients suffered at least one postoperative complication; 77, 91, and 20 patients experienced grade I, II, and III-IV complications, respectively. In the univariate analysis, sex, diabetes mellitus, postoperative hemoglobin, and postoperative albumin are statistically significant. In the multivariable analysis, postoperative albumin (adjusted odds ratio (OR) = 0.861, P < 0.001) was an independent risk factor of the postoperative complication severity in patients with STB. Receiver operating characteristic (ROC) analysis showed that the optimal cutoff values for postoperative albumin were 32 g/L (sensitivity: 0.571, specificity: 0.714, area under the ROC curve: 0.680) and 30 g/L (sensitivity: 0.649, specificity: 0.800, area under the ROC curve: 0.697) for grade II and grade III-IV complications, respectively. Conclusions Postoperative albumin is an independent risk factor for postoperative complication severity in patients with STB. The improvement of postoperative albumin levels may reduce the risk of severe complications in patients with STB.

Clinical Efficacy of CT-Guided Continuous Catheterization Drainage for Spinal Tuberculosis with Large Abscesses.

Objective This study aimed to determine the efficacy of computed tomography (CT)-guided local catheterization for the treatment of spinal tuberculosis (TB) with abscess. Methods Clinical data from 22 cases of lumbar TB with abscess receiving treatments from July 2015 to January 2021 were analyzed. Some patients (n = 11) underwent pure surgery (control group) and the others (n = 11) received CT-guided catheterization drainage. The operation and hospitalization time, erythrocyte sedimentation rate (ESR), visual analog scale (VAS), ASIA damage grade, and C-reactive protein (CRP) levels of both groups were compared. Results The operation time, intraoperative blood loss, and hospital stay of the observation group were significantly less than those of the control group (P < 0.05). As the differences in preoperative ESR, CRP, and VAS scores between both groups did not reach significance (P > 0.05), after treatments, the observation group had a lower level of ESR and CRP (P < 0.05); the postoperative VAS scores of the two groups decreased (P > 0.05). Before treatment, the control group comprised 2 cases of ASIA grade A, 1 case of B, 6 cases of C, and 2 cases of D with 3 patients having dyskinesia. After surgery, the motor function of the patients was improved, and there were 3 cases of ASIA D and 8 cases of E. Meanwhile, the preoperative observation group consisted of 9 cases of ASIA D and 2 cases of E. Due to CT-guided catheterization, all patients achieved clinical healing (ASIA E) when the lesions were significantly alleviated, and symptoms such as low back pain and lower extremity pain disappeared. Conclusion CT-guided percutaneous catheter drainage for continuous administration of drugs is effective treatment for spinal TB with abscess, when shortening the operation and hospitalization time and reducing intraoperative blood loss and erythrocyte sedimentation rate. It is worthy of popularization and application.

Routine preoperative examination for diagnosis of periprosthetic joint infection and its recurrence in revision hip arthroplasty

To evaluate diagnostic value of routine preoperative laboratory tests such as erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and microbiological examination of joint aspirate in patients with periprosthetic joint infection or its recurrence in patients scheduled for revision hip arthroplasty. There were 117 patients. Preoperative CRP and ESR, the culture of pre- and intraoperative joint aspirates and tissue biopsies were studied. We analyzed diagnostic significance of these parameters and the likelihood of periprosthetic joint infection depending on increase of CRP/ESR and previous joint infection. According to microbiological data, periprosthetic joint infection was diagnosed in 19.7% of patients. High CRP in this group significantly increased the chance of joint infection diagnosis (OR 6.3; 95% CI 1.491-26.615). Concomitant increase of both ESR and CRP increased this likelihood by 7.7 times (OR 7.778; 95% CI 0.931-66.296). In the 2nd group, periprosthetic joint infection was confirmed in 25% of patients. At the same time, detection of pathogen in isolated or combined increase in CRP and ESR was less likely compared to the control group. Prognostic value of negative preoperative microbiological examination of joint aspirate was only 93%. We failed to obtain aspirate in 21.4% of cases. Increase of the routine serological parameters before revision hip arthroplasty is more sensitive for prediction of periprosthetic joint infection in patients without previous infection. Previous joint infection reduces diagnostic value of ESR and CRP in detection of recurrent periprosthetic joint infection. Preoperative examination of joint aspirate is not sufficient for etiological diagnosis of periprosthetic joint infection. However, positive microbiological culture should be taken into account for the choice of further management.

13. The diagnostic utility of biomarkers: spinal instability or underlying infection

<h3>BACKGROUND CONTEXT</h3> Surgical site infection is a devastating complication of surgery that increases morbidity for patients undergoing spinal surgery. However, diagnosis in some cases remains challenging often requiring a trip to the operating room to obtain cultures. Current literature has provided evidence that preoperative blood markers are diagnostic of infection in patients undergoing hip arthroplasty and total knee replacement, but there has been limited investigation on biomarker diagnostic utility in patients undergoing spinal surgery. <h3>PURPOSE</h3> To identify the diagnostic utility of laboratory markers to diagnose postoperative spinal infection. <h3>STUDY DESIGN/SETTING</h3> Retrospective case-control analysis <h3>PATIENT SAMPLE</h3> Patients having undergone prior spine surgery with a confirmed positive intraoperative culture during revision for presumed infection. An additional aseptic cohort was established with patients undergoing revision surgery for reasons other than infection. <h3>OUTCOME MEASURES</h3> White blood cell (WBC), erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), mean platelet volume (MPV), platelet number, MPV/platelet ratio, diagnostic sensitivity, specificity and threshold values for the diagnosis of spinal infection. <h3>METHODS</h3> A retrospective review was conducted at a single center academic hospital. Patients undergoing spinal fusion with a diagnosis of surgical site infection (SSI) from the dates of 2013 to 2019 were identified. In the aseptic cohort, any individual that had overt signs of infection or had infection within one year of revision procedure was excluded. Patients with a history of cancer, trauma, autoimmune disease on suppressive therapy, or noncompliance with medical therapy were excluded. WBC, ESR, CRP, MPV, MPV/Platelet ratio and demographic data was compared between groups and an AUC analysis was performed to determine threshold values. <h3>RESULTS</h3> A total of 418 patients were included, 224 in the aseptic cohort and 194 in the infection cohort. In terms of baseline demographics, there were significant differences between the cohorts in BMI, CCI, and ASA (p<0.05). BMI in the infection cohort was found to be greater than the aseptic cohort with a mean value of 33.7 vs 30.9 respectively. CCI and ASA was also elevated in the infections cohort as compared to the aseptic cohort with mean values of 3.84 for CCI and 2.90 for ASA as compared to 1.08 and 2.45 in the aseptic cohort. Significant differences were found between the cohorts with respect to MPV/platelet ratios, platelet number, MPV, CRP, ESR and WBC (p<0.01). Platelet ratio, platelet number, CRP, ESR and WBC were all greater in the infection group as compared to the aseptic group (platelet ratio 36.1 vs 24.7, platelet number 347 vs 249, CRP 9.99 vs 4.81, ESR 76.6 vs 46.5, WBC 9.87 vs 7.82 p<0.01) These differences were used to determine predictive cutoffs. The most sensitive markers for predicting postoperative infection were platelet number (cutoff 284 AUC 0.751; sensitivity 0.662) and ESR (cutoff 40.00 AUC 0.715; sensitivity 0.838). The most specific markers for predicting postoperative infection were platelet ratio (cutoff 31.02 AUC 0.758; specificity 0.842) and platelet count (cutoff 284.00 AUC 0.715; specificity 0.804). <h3>CONCLUSIONS</h3> This study concluded that preoperative platelet number and ESR are best used as screening measures, while MPV/platelet ratio and count are useful confirmatory markers. Further analysis will allow for a more depth investigation into optimal combination of biomarkers to result in the greatest diagnostic utility, but this initial report serves as evidence that preoperative biomarker collection may be a valuable tool to confirm the diagnosis in suspected postoperative surgical site infections. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Diagnostic value of routine pre-operative investigations used in combination in the diagnosis of periprosthetic joint infection

The primary aim of this study was to assess the diagnostic accuracy of joint aspiration culture, serum C-reactive protein (CRP) and serum erythrocyte sedimentation rate (ESR), individually, and in combination for the diagnosis of periprosthetic joint infection (PJI). A consecutive patient series with pre-operative inflammatory marker levels, an aspiration culture of either hip or knee arthroplasty and intra-operative culture samples from subsequent revision surgery was compiled. This retrospective patient cohort analysis included 128 aspiration. The data were analysed to compare pre-operative aspiration cultures, serum ESR and CRP levels to the chosen gold standard for PJI diagnosis of intra-operative culture samples. A diagnostic algorithm was created using the above tests combined with clinical suspicion index. The values that had the highest sensitivity and specificity of predicting PJI were >5 for CRP and >16 for ESR. CRP used individually had the highest sensitivity and negative predictive value (NPV) of any test (75.0% and 75.9%, respectively). ESR + aspirate had the highest specificity and positive predictive value (PPV), of 100% for both. Using all three tests together the specificity and PPV were higher than the test individual values (95.3% and 85.0% respectively). Based on subgroup analyses the combination of ESR or CRP plus joint aspiration has superior PPV compared to individual tests. ESR and CRP had the highest NPV when used in isolation. An algorithm has been developed to guide clinical diagnosis.

Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection: What Predicts Success or Failure?

BackgroundDebridement, antibiotics and implant retention (DAIR) is the treatment of choice for acute postoperative and acute hematogenous periprosthetic joint infection (PJI). There is limited literature on predictive prognostic factors for DAIR. We aim to report the outcomes of DAIR and investigate the predictive prognostic factors. MethodsWe retrospectively reviewed 106 DAIRs. Failure was defined as requiring removal of TKA implants. Predictive factors that may influence success of DAIR treatment such as age, gender, body mass index, ethnicity, American Society of Anesthesiologists score, comorbidities, preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein, symptom duration, time between total knee arthroplasty and DAIR, cultures, rifampicin use, polyethylene liner change, and antibiotic duration were analyzed. ResultsThe success rate of DAIR was 69.8% (74/106 patients). For successes, mean time from DAIR-to-mortality was longer than failures (61.6 ± 42.7 vs 9.75 ± 9.60 months, P = .0150). Methicillin-susceptible Staphylococcus aureus PJI (odds ratio [OR] 3.64, confidence interval [CI] 1.30-10.2, P = .0140) was a significant predictor for failure of DAIR. Higher preoperative ESR correlated to failure (OR 1.02, CI 1.01-1.04, P = .008). In successes, mean ESR was 75.4 (66.1-84.6), whereas mean ESR in failures was 116 (88.3-143) (P = .011). An ESR > 107.5 predicted failure with a sensitivity of 51.5 and specificity of 85.2. ESR > 107.5 correlated to failure (OR 6.60, CI 2.29-19.0, P < .001). Repeat DAIRs were strongly correlated to failure (OR 5.27, CI 1.99-13.9, P < .01). ConclusionDAIR failure is associated with earlier time to mortality. Repeat DAIRs, elevated ESR > 107.5, and S aureus PJI are associated with treatment failure and 2-stage revision is recommended.

The Natural Course of Serum D-Dimer, C-Reactive Protein, and Erythrocyte Sedimentation Rate Levels After Uneventful Primary Total Joint Arthroplasty

BackgroundThis study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty. MethodsThis prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR. ResultsThe mean preoperative serum D-dimer, CRP, and ESR level was 412 ± 260 (range 200-980) ng/mL, 2.93 ± 2.1 (range 1-18) mg/L, and 22.88 ± 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively. ConclusionD-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.

Factors Associated With Elevated Inflammatory Markers Prior to Shoulder Arthroplasty.

Background: Preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) ranges for several shoulder arthroplasty indications are not well understood. Purpose: We sought to compare preoperative ESR and CRP values for a variety of shoulder arthroplasty indications and evaluate risk factors for elevated preoperative ESR and CRP values. Methods: We conducted a retrospective cohort study of shoulder arthroplasty cases performed at a single academic medical institution from 2013 to 2018. Preoperative ESR and CRP values for 235 shoulder arthroplasties with various indications were recorded. Independent risk factors for elevated values (CRP > 10.0 mg/L and ESR > 30.0 mm/h) were determined via multiple variable logistic regression. Results: Patients undergoing shoulder arthroplasty for osteoarthritis had an ESR (mean ± SD) of 22.6 ± 17.8, with 29.8% of patients elevated, and a CRP of 6.5 ± 6.4, with 25.5% of patients elevated. Arthroplasty for acute fracture and prosthetic joint infection (PJI) had higher preoperative ESR and CRP values. Multivariate analysis identified several predictors of elevated ESR, including infection, acute fracture, diabetes, and female sex. It also identified predictors of elevated CRP, including infection, acute fracture, and younger age. Conclusions: Preoperative ESR and CRP values may be elevated in 25% to 30% of patients undergoing primary shoulder arthroplasty. Arthroplasty for both acute fracture and PJI, along with several other patient factors, was associated with elevated preoperative ESR and CRP. Thus, routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common. Further study is warranted.

Exciting Performance of Plasma Fibrinogen in Periprosthetic Joint Infection Diagnosis.

ObjectiveTo test the significance of serum C‐reactive protein (CRP), the erythrocyte sedimentation rate (ESR), the platelet count/mean platelet volume ratio (PC/MPV), plasma fibrinogen, and D‐Dimer in periprosthetic joint infection (PJI) diagnosis.MethodsWe retrospectively analyzed the clinical data of 149 patients diagnosed from July 2016 to December 2019 with primary osteoarthritis (OA group, average age 63.18 years [range, 53–82 years] 18 males, 46 females), PJI (PJI group, average age 63.74 years [range, 52–81 years], 16 males, 31 females), and aseptic loosening (aseptic group, average age 63.18 years [range, 53–80 years], 12 male, 26 female) in our department. Demographic data and the sensitivity and specificity of preoperative CRP, ESR, PC/MPV, fibrinogen, and D‐Dimer in PJI diagnosis were compared.ResultsThere were no significant differences when the demographic data of the three groups were compared. The expression level of CRP (50.67 ± 58.98 mg/L), ESR (50.55 ± 25.81 mm/h), PC/MPV (35.79 ± 18.00), and fibrinogen (4.85 ± 1.33 μg/mL) in the PJI group were higher than in the OA group (CRP: 4.09 ± 9.68 mg/L; ESR:13.44 ± 9.32 mm/1 h; PC/MPV: 24.97 ± 7.58; fibrinogen: 3.09 ± 0.55 μg/mL) and the aseptic group (CRP: 7.01 ± 11.83 mg/L; ESR: 22.47 ± 17.53 mm/1 h; PC/MPV: 25.18 ± 11.48; fibrinogen: 3.39 ± 0.80 μg/mL), respectively. The expression level of plasma D‐dimer (1.60 ± 1.29 mg/L) in the PJI group was higher than in the OA group (0.49 ± 0.42 mg/L) but similar to that in the aseptic group (1.21 ± 1.35 mg/L). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, PC/MPV, fibrinogen, and D‐dimer were 0.892 (95% confidence interval, 0.829–0.954), 0.888 (0.829–0.947), 0.686 (0.589–0.784), 0.873 (0.803–0.943), and 0.835 (0.772–0.899), respectively. When PC/MPV > 31.70, fibrinogen >4.01 μg/mL, and D‐dimer >1.17 mg/L were set as the threshold values for the diagnosis of PJI, the sensitivity of PC/MPV in PJI diagnosis was lower than that of ESR and plasma fibrinogen. In contrast, there was no significant difference when comparing the specificity of CRP, ESR, PC/MPV, fibrinogen, and D‐dimer in PJI diagnosis.ConclusionPlasma fibrinogen is a good new auxiliary diagnostic marker for PJI.

Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

BackgroundTo explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia.MethodsData on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery.ResultsThe mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months.ConclusionsEarly surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.