Evaluation value of stress hyperglycemia ratio combined with C-reactive protein and procalcitonin in the evaluation of postoperative infection in patients with open tibiofibular fracture / 中国综合临床

ABSTRACT

Objective:To explore the the evaluation value of stress hyperglycemia ratio (SHR), C-reactive protein (CRP), and serum procalcitonin (PCT) for postoperative infection in patients with open tibiofibular fractures.Methods:This study was a prospective analysis. Patients with open tibiofibular fractures hospitalized in the Department of Orthopaedic Surgery of The Second Hospital of Tangshan and North China University of Science and Technology Affiliated Hospital from January 2018 to January 2023 were collected as the research objects, and a total of 839 cases were assessed for outcome, which were divided into infection group (103 cases) and non-infection group (736 cases) according to whether the selected subjects had postoperative infection. The clinical data of the two groups were analyzed by univariate analysis, and the risk factors of postoperative infection of open fracture of tibia and fibula were analyzed by multivariate Logistic regression, and the receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of SHR, CRP, PCT, and their combined models on adverse outcomes.Results:Univariate analysis showed that the infection group had SHR (1.82±0.31), CRP (92.28±36.07) mg/L, PCT (6.35±1.79) μg/L, the non infection group had (1.05±0.12), (56.35±10.21) mg/L and (2.17±0.41) μg/L, respectively, and there were significant differences between the two groups ( t values were 46.90, 21.60, and 54.17, respectively; all P<0.001). The proportion of albumin (<30 g/L) in the infection group was higher than that in the non-infection group (63.11%(65/103), 37.64%(277/736) (χ 2=24.28, P<0.001), and the two groups had significant differences in the rate of time from injury to operation (the infection group ≥6 h was 71.84%(74/103), <6 h was 28.16%(29/103); the non-infection group ≥6 h was 43.07%(317/736), <6 h was 56.93%(419/736); χ 2=35.37, P<0.001), the rate of Gustilo-Anderson classification (the infection group Ⅰ、Ⅱ was 44.46%(46/103), ⅢA was 33.98%(35/103), ⅢB was 12.62%(13/103), ⅢC was 8.47%(9/103);the non-infection groupⅠ、Ⅱ was 59.10%(435/736), ⅢA was 32.47%(239/736), ⅢB was 5.98%(44/736), ⅢC was 2.45%(18/736); χ 2=20.34, P<0.001) and the rate of postoperative drainage volume (the infection group was 40.60%(48/103),the non-infection group was 58.02%(427/736); χ 2=4.79, P=0.029). Multivariate Logistic regression analysis showed that SHR ( OR=1.871,95% CI 1.621-2.160, P<0.001), CRP ( OR=1.060, 95% CI 1.015-1.107, P=0.009), PCT ( OR=1.497, 95% CI 1.420-1.577, P<0.001) were independent risk factors for postoperative infection in open tibiofibular fractures. Among them, SHR had the highest OR value, which was the strongest factor affecting the outcome of the study. Other independent factors were age ( OR=1.052, 95% CI 1.038-1.066, P<0.001) and Gustilo-Anderson type-ⅢC ( OR=1.875, 95% CI 1.038-2.015, P<0.001). By drawing the ROC curve of SHR, CRP, PCT and their combined model to predict the incidence of postoperative infection in open tibiofibular fractures, the results showed that the combined model had higher diagnostic predictive value than the single application, and its sensitivity and specificity were 86.4% and 70.4%, respectively, which were higher than the sensitivity (78.6%, 77.7%, 75.7%) and specificity (69.2%, 69.3%, 69.6%) of the single assessment. Conclusion:The combined model of SHR, CRP and PCT has a higher predictive value than the single detection, which can provide a better clinical basis for the early diagnosis of postoperative infection in patients with open tibiofibular fractures.