| Objective:To study and analyze the preoperative body mass index(BMI),hemoglobin(HGB),platelet count(PLT),total lymphocyte count(LY),albumin(ALB),serum prealbumin(PA),fibrinogen(FIB),and calculate the ratio of albumin count to fibrinogen count(AFR)and prognostic nutritional index(PNI)in arthroplasty patients,and to investigate its The diagnostic value and clinical significance of periprosthetic infection(PJI)were investigated.Method:119 patients who underwent joint revision in the People’s Hospital of Guangxi Zhuang Autonomous Region from January 2013 to January 2023and met the inclusion and exclusion criteria of this study were retrospectively analyzed and divided into 41 cases in the infected group and 78 cases in the non-infected group according to the MSIS criteria(see Appendix),by collecting the patients’preoperative body mass index(BMI),hemoglobin(HGB),platelet count(PLT),total lymphocyte count(LY),albumin(ALB),serum prealbumin(PA),fibrinogen(FIB)and other nutrition-related indexes,as well as calculated AFR and PNI values,and analyzed the sensitivity and specificity of each nutrition index and related ratio by using the subject operating characteristic curve(ROC),and calculated the Jorden index and area under the ROC curve(AUC)to analyze The value and significance of each index in the diagnosis of post-arthroplasty complications of periprosthetic infection.For the meaningful indexes,joint ROC curves were plotted and AUC was calculated to evaluate the diagnostic efficacy of each nutritional index and related ratios for PJI.Result:1.Comparison between groups for basic information:p-values of0.244,0.593,and 0.157 for gender,age,and surgical site,respectively,were greater than 0.05,with no statistically significant differences.2.Comparison between groups for serum prealbumin,platelet count,total lymphocyte count,and BMI values:median value of 217.00(mg/L)for the infected group and220.00(mg/L)for the non-infected group for serum prealbumin The median value of serum prealbumin was 220.00(mg/L)in the infected group and 220.00(mg/L)in the non-infected group,Z=1.418,P=0.156,with no statistically significant difference(P>0.05);the median value of platelet count was 280.00(10^9/L)in the infected group and 255.00(10^9/L)in the non-infected group,Z=1.541,P=0.123,with no statistically significant difference(P>0.05)The median value of total lymphocyte count was 1.75(10^9/L)in the infected group and 1.81(10^9/L)in the non-infected group,Z=0.833,P=0.405,the difference was not statistically significant(P>0.05);the mean value of BMI was 24.25(kg/m~2)in the infected group and 25.22(kg/m~2)in the non-infected group,Z=The difference was not statistically significant(P>0.05).3.Comparison between groups of hematocrit,albumin,fibrinogen,PNI and AFR values:the mean value of hematocrit was 115.98(g/L)in the infected group and 126.99(g/L)in the non-infected group,Z=10.626,P=0.001<0.05,the difference was statistically The mean value of albumin was 36.58(g/L)in the infected group and 39.19(g/L)in the non-infected group,Z=12.225,P=0.001<0.05,a statistically significant difference;the median value of fibrinogen was 4.04(g/L)in the infected group and 3.62(g/L)in the non-infected group,Z=2.483,P=0.013<0.05,a statistically significant difference;the mean value of PNI value was 46.09 in the infected group and 48.96 in the non-infected group,Z=7.909,P=0.006<0.05,a statistically significant difference;the mean value of AFR value was 9.08 in the infected group and 11.01 in the non-infected group,Z=3.277,P=0.001<0.05,a statistically significant difference.The differences were statistically significant.4.Intergroup comparison of ROC curves for hematocrit,albumin,fibrinogen,PNI,and AFR values:hematocrit corresponded to a critical value of 107(g/L)at the maximum of the Jorden index,and the sensitivity and specificity obtained at this time were 41.46%and 94.87%,respectively,with an AUC of 0.635,within the95%confidence interval[0.542-0.721]Within the 95%confidence interval[0.542-0.721],P=0.028<0.05,the difference was statistically significant;the sensitivity and specificity of albumin were 46.34%and 92.31%,respectively,with an AUC of 0.684,within the 95%confidence interval[0.592-0.766],P=0.001<0.05,the difference was statistically significant;the sensitivity and specificity of fibrinogen were 41.46%and 94.87%,respectively,with an AUC of0.635,within the 95%confidence interval[0.542-0.721],P=0.001<0.05,the difference was statistically significant.The sensitivity and specificity of fibrinogen were 41.46%and 87.18%,respectively,with an AUC of 0.639,within the 95%confidence interval[0.546-0.725],P=0.014<0.05.The difference was statistically significant;the PNI was 42.32(g/L)at the maximum of the Jorden index.The sensitivity and specificity were 36.59%and 92.31%,respectively,with an AUC of 0.643,within the 95%confidence interval[0.550-0.729],P=0.014<0.05,which was statistically significant;the sensitivity and specificity of the AFR were 70.44 and 10.44,respectively,with the maximum Jorden index.The sensitivity and specificity of AFR were 70.73%and62.82%,respectively,and the AUC was 0.683,within the 95%confidence interval[0.592-0.765],P=0.001<0.05,which was statistically significant.5.The combined analysis of hematocrit,albumin,fibrinogen,PNI,and AFR values:hematocrit,albumin,fibrinogen,PNI,and AFR The sensitivity and specificity were 39.02%and 97.44%,respectively.The AUC was 0.707,which was within the 95%confidence interval[0.617-0.787],P<0.001,and the difference was statistically significant and outstanding in specificity.Conclusion:1.In predicting PJI,serum prealbumin,platelet count,total lymphocyte count and BMI values did not show statistically significant differences between the infected and non-infected groups,and did not show much clinical diagnostic value.2.The value of the combined test for predicting PJI was significantly higher than that of the five independent tests,and the combined test for predicting PJI before arthroplasty is recommended and has a higher specificity. |
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