Predictive value of post-operative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery

Shen, Chaojun; Miao, Tao; Wang, Zhangfu; Li, Zhenfa; Huang, Lingqin; Chen, Tingting; Yan, Wei‐Hua

doi:10.1016/j.intimp.2019.105705

Cited by 32 publications

(36 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Applying EBJIS criteria, we could confirm this inferior performance of WBC (sensitivity 36%, specificity 89%) in our study. Percentage of neutrophils and the neutrophils to lymphocytes ratio showed promising results in diagnosing other infectious conditions such as appendicitis, surgical site infections or bloodstream infections [4,5,7] but could only obtain moderate results when diagnosing PJI. With sensitivities of about 60% and specificities of about 70%, these parameters did not aid in diagnosing PJI.…”

Section: Discussionmentioning

confidence: 99%

“…Other potential serum inflammatory markers which have been correlated with infection in other infectious conditions are fibrinogen [2,3], the percentage of neutrophils (%N) and the neutrophils to lymphocytes ratio (NLR) [4][5][6][7]. While the performance of %N and NLR was not investigated previously, serum fibrinogen was shown to be highly sensitive (90%) but unspecific (34%) for detecting PJI [8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections

Sigmund

Holinka

Staats

et al. 2020

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Besides other diagnostic test methods, established serum inflammatory markers such as serum C-reactive protein or leukocyte count are widely used preoperatively to aid in diagnosing periprosthetic joint infections (PJI). Although low accuracies were reported, these parameters are easily accessible and routinely available. Novel biomarkers with promising results in diagnosing PJI (platelet count to mean platelet volume ratio) or other infectious conditions (percentage of neutrophils, neutrophils to lymphocytes ratio) were described. The purpose of this study was to investigate the diagnostic value of established and novel serum inflammatory biomarkers for the diagnosis of PJI so as to compare the results to find the serum inflammatory marker with the best performance. Methods In 177 patients with a previous total hip (n = 91) or knee (n = 86) arthroplasty and indicated revision surgery, the diagnostic value of the routinely available serum inflammatory markers C-reactive protein (CRP), white blood cell count (WBC), percentage of neutrophils (%N), neutrophils to lymphocytes ratio (NLR), fibrinogen and platelet count to mean platelet volume ratio (PC/mPV) were examined retrospectively via receiver operating characteristic curve analysis (AUC). The curves were compared using the z-test. Results Sensitivities of serum CRP, WBC, %N, NLR, fibrinogen and PC/mPV were calculated with 68%, 36%, 66%, 63%, 69% and 43%, respectively. Specificities were 87%, 89%, 67%, 73%, 89% and 81%, respectively. Serum CRP (0.78) and fibrinogen (0.79) showed significantly better AUCs compared with serum WBC (0.63), %N (0.67), NLR (0.68) and PC/mPV (0.62) (p < 0.0001). Patients with PJI caused by a low-virulent microorganism (median CRP: 17.6 mg/L) obtained lower CRP levels compared with infections caused by high-virulent microorganisms (median CRP: 49.2 mg/L; p = 0.044). The combination of CRP and fibrinogen showed a better sensitivity (77%) with similar specificity (83%) than one method alone but not at a significant level (CRP (p = 0.200); fibrinogen (p = 0.437)). Conclusion Serum CRP and fibrinogen showed the best accuracies among these widely available serum inflammatory parameters. However, due to the insufficient performance, these biomarkers can only be recommended as suggestive criteria in diagnosing PJI. The preoperative workup should always be complemented by more specific tests such as synovial fluid analysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections

Sigmund

Holinka

Staats

et al. 2020

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Indeed, after posterior lumbar spinal surgery, a retrospective study showed that NLR at postoperative 7 days was a useful marker for detecting postoperative infections. 13,14 However, among patients who underwent posterior lumbar spinal surgery, the incidence and characteristics of SSI were reportedly different between those who underwent instrumentation surgery and those who underwent non-instrumentation surgery. 4,15 Moreover, laboratory markers such as C-reactive protein (CRP) and white blood cell (WBC) count are affected by addition of instrumentation.…”

Section: Introductionmentioning

confidence: 99%

“…16 Thus, in the case that laboratory markers are useful for the prediction of SSI after spinal decompression surgery, the cutoff value in spinal decompression surgery should be calculated separately from spinal instrumentation surgery. While the usefulness of NLR was established in the detection of bacteremia in emergency department, 10 diagnosis of bacterial infection among patients hospitalized for fever, 11 prediction of hospital-acquired bacterial infections in decompensated cirrhotic patients, 12 and prediction of SSI among patients following spinal instrumentation surgery, 14 there have been no reports which investigated the diagnostic value of NLR for the early prediction of SSI and its cutoff value in spinal decompression surgery. Therefore, the diagnostic value of NLR for predicting SSI in spinal decompression surgery cohort should be investigated.…”

Section: Introductionmentioning

confidence: 99%

Postoperative lymphocyte percentage and neutrophil–lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery

Inose

Kobayashi

Yuasa

et al. 2020

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Purpose: Although the neutrophil–lymphocyte ratio (NLR) is a simple biomarker for inflammation, its diagnostic value for predicting surgical site infection (SSI) after spinal decompression surgery has not been extensively investigated. We aimed to determine the predictive value of NLR for SSI in patients undergoing spinal decompression surgery. Methods: We performed a retrospective observational study of patients who underwent spinal decompression surgery. Consecutive 254 patients were divided into an SSI group and a non-SSI group based on the presence of SSI. We evaluated which markers, including NLR, differed significantly between groups. We then determined the diagnostic cutoff values of these markers for the prediction of SSI based on the significance in the univariate analysis. Results: The incidence of SSI was 7 of 254 patients (2.8%). Univariate analysis showed that there were significant differences in the C-reactive protein (CRP) level at 1 day postoperatively; neutrophil and lymphocyte percentage and NLR at 3–4 days postoperatively; and CRP level, white blood cell count, neutrophil count and percentage, lymphocyte percentage, and NLR at 6–7 days postoperatively between SSI and non-SSI groups. Among these markers, the cutoff values of lymphocyte percentage and NLR at 3–4 days postoperatively for the prediction of SSI were ≤15.1% and ≥4.91, respectively. The cutoff values of lymphocyte percentage and NLR at 6–7 days postoperatively were ≤19.8% and ≥3.21, respectively. Conclusions: Lymphocyte percentage and NLR at 3–4 and 6–7 days postoperatively were useful markers for the early prediction of SSI in patients who had undergone spinal decompression surgery. These parameters may aid in identifying patients at higher risk of SSI after spinal decompression surgery.

show abstract

“…Colonized bacteria may begin to replicate and adhere to the surgical wounds if the host's immune response is not sufficient to overcome the bacteria's effect. NLR is one of the commonly used and convenient inflammatory markers that reflect this immune response [33], and it has been applied for the prediction of SSI in patients after several surgical operations such as colorectal [34], total knee arthroplasty [35], lumbar spinal [36], and head and neck cancer [37]. Yombi JC et al found that NLR was a superior biomarker than C-reaction protein (CRP) to be included in the follow-up of early infectious complications after total knee arthroplasty, because it had a faster normalization than CRP [35].…”

Section: Non-controllable Risk Factorsmentioning

confidence: 99%

Surgical site infection following elective mesh repair of inguinal hernia: an analysis of risk factors

Zhuo

Chen

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Surgical site infection (SSI) is a complication of mesh repair of inguinal hernia (IH) with an increase in length of stay and costs. We investigated both controllable and non-controllable risk factors for SSI following elective mesh repair of IH. Methods: A retrospective analysis was conducted of 1177 adult patients who underwent elective mesh repair of IH (not receiving antibiotic prophylaxis) from January 2010 to September 2019. Demographics, surgical variables and laboratory data were extracted from the electronic medical records. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of continuous variables. Independent risk factors for SSI were identified by univariate and multivariate analyses. Results: In total, 647 open and 530 laparoscopic IH repairs were included. The overall SSI rate within 30 days after surgery was 3.2% (39/1342 hernias) in the absence of antibiotic prophylaxis. Both the preoperative neutrophil‐lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were negatively correlated with the postoperative period of SSI (r = -0.368, P = 0.021; r = -0.334, P = 0.038, respectively). On multivariate analyses, body mass index (BMI) > 24.6 kg/m 2 (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.041-1.275), current smoker (OR, 4.226; 95% CI, 1.222-14.611), preoperative NLR > 1.97 (OR, 3.670; 95% CI, 1.675-8.041), and open approach (OR, 4.866; 95% CI, 1.877-12.618) were significantly related to postoperative SSI. Conclusion: The controllable risk factors (elevated BMI, current smoker) found out here may help to identify patients at high-risk of SSI, allowing targeted preventive measures. Preoperative NLR > 1.97 is a previous unrecorded predictor for SSI following elective mesh repair of IH. Further study is needed to ascertain the magnitude of their effect.

show abstract

Predictive value of post-operative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery

Cited by 32 publications

References 23 publications

Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections

Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections

Postoperative lymphocyte percentage and neutrophil–lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery

Surgical site infection following elective mesh repair of inguinal hernia: an analysis of risk factors

Contact Info

Product

Resources

About