| Objective:The study aims to explore the risk factors of postoperative infection after cell deactivation is combined with abdominal heat perfusion,and to observe the infection status of patients after cell deactivation is combined with abdominal heat perfusion,and the value of postoperative white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT)and systemic immune inflammatory index(SII)in predicting postoperative infection.Methods:The clinical data of 106 patients who underwent CRS+HIPEC surgery in Shanxi People’s Hospital from July 2019 to July 2022 were retrospectively investigated,which were divided into the infected group(19 cases)and the non-infected group(87 cases),and the secondary postoperative infection(19 cases)and related risk factors were analyzed.The postoperative white blood cell count,C-reactive protein,procalcitonin and systemic immune inflammatory index were determined to determine their prognostic value.Univariate and multivariate Logistic regression were used to analyze the risk factors of postoperative secondary infection in patients with CRS+HIPEC.The predictive value of WBC,PCT,CRP and SII was evaluated by drawing receiver operating characteristic(ROC)curves,and the optimal cut-off value of variables was determined by using Youden index,using sensitivity,specificity,positive predictive value and negative predictive value as evaluation indexes.Test level α=0.05,P<0.05 was statistically significant.R software was used to build a line graph prediction model,and samples were included in the line graph to calculate the total score of the line graph,and ROC curve analysis and calibration curve verification were carried out.Results:Univariate analysis showed that age,BMI,postoperative fistula,preoperative serum albumin,combined with multiple organ resection,and operation duration had statistical differences(P<0.05).The WBC,CRP,PCT and SII of the infected group and the non-infected group at 1,3,5 and 7 days after surgery were compared between groups.The results showed that there was no statistical significance in WBC,CRP and SII on the first day after surgery,WBC and SII on the third day after surgery,CRP and SII on the fifth day after surgery and SII on the seventh day after surgery.There were statistically significant differences in PCT on the 1st day after surgery,PCT and CRP on the 3rd day after surgery,WBC and PCT on the 5th day after surgery and WBC,PCT and CRP on the7 th day after surgery.ROC curve was drawn.By comparing the area under the receiver operating characteristic curve(AUC),95% confidence interval,sensitivity and specificity of WBC,CRP,PCT and SII at 1,3,5 and 7 days after operation,the predictive value of POD5 WBC,PCT and POD7 CRP was better than other test indexes at other times.SII had no predictive value in predicting postoperative secondary infection in patients with CRS-HIPEC.The cut-off values of POD5 WBC,PCT and POD7 CRP were7.7×10^9/L,2.068 ng/m L and 76.43 mg/L,respectively.The AUC values were 0.754,0.830 and 0.715,respectively.Sensitivity was 0.789,0.684 and 0.632,respectively.The specificity was 0.701,0.965 and 0.759,respectively.95% confidence interval(0.625,0.883 respectively),(0.717,0.943),(0.584,0.846).The predictive values of POD1,3,5 and 7 PCT were better than those of WBC,CRP and SII measured on the same day.The cut-off values of POD5 WBC,PCT and POD7 CRP were taken as the classification threshold,and the results after classification and the single factor meaningful variables—age,BMI,postoperative fistula,preoperative serum albumin,number of organ excision and duration of operation were analyzed by multivariate Logistic regression.The results showed that BMI,combined multiple organ resection,POD5 WBC,PCT and POD7 CRP were independent risk factors for secondary infection(P<0.05),and then a Nomogram model was established.Point indicates the score corresponding to each variable.BMI ≥ 25 kg/m ~2 corresponds to 70 points;when combined with multiple organ excision,the corresponding score was 80;POD5 PCT≥2.068 ng/m L corresponds to 69 points;POD5 WBC≥ 7.7×10^9/L corresponds to 100points;POD7 CRP≥76.3 corresponds to 79 points.The sum of the scores for each variable is the patient’s total score.The ROC curve was analyzed and the calibration curve was calibrated.According to the ROC curve,the AUC was 0.966,the sensitivity was 0.895,and the specificity was 0.966,indicating that the model had good differentiation.The calibration curve test level is α=0.05,the absolute error between prediction and actual occurrence of CRS-HIPEC postoperative infection AL is 0.038.Conclusion:The secondary infection of patients after CRS-HIPEC surgery was correlated with BMI,combined multiple organ resection and other factors.Peripheral blood inflammatory indicators PCT,CRP and WBC can be used as predictors of postoperative secondary infection in patients with CRS-HIPEC.POD5 WBC,PCT and POD7 CRP had the greatest diagnostic value for infectious complications,and the predictive value of combined diagnosis was better than that of single indicator test. |
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