术前KLIC评分对清创、假体保留联合抗生素治疗急性假体周围感染效果的预测价值

目的 探讨KLIC（kidney, liver, index surgery, cemented prosthesis and C reactive protein value）评分系统用于预测清创、假体保留联合抗生素方案（DAIR）治疗急性假体周围感染（PJI）结果的准确性。方法 回顾性研究。纳入2015年1月—2020年12月南京大学医学院附属金陵医院骨科急性PJI患者44例,其中男17例、女27例,年龄21~86岁,均行DAIR。结合病史和检验结果,计算患者术前KLIC评分,并按评分结果将患者分为KLIC评分≤2分组、2.5~3.5分组、4~5分组、5.5~6.5分组和≥7分组。比较各组患者基线资料、住院时间和DAIR治疗结果的差异。采用受试者操作特征曲线（ROC）来评价KLIC评分系统预测DAIR治疗结果的准确性;以DAIR失败作为终点事件,采用Kaplan-Meier绘制累积治疗成功率曲线。结果 5组患者年龄、性别、体质量指数（BMI）、病变部位、感染分类、感染症状持续时间、术后住院时间等基线资料比较,差异均无统计学意义（P值均>0.05）。5组患者总体治疗成功率为61.36%（27/44）、失败率为38.64%（17/44）;KLIC评分≤2、2~3.5、4~5、5.5~6.5分和≥7分5组的失败率分别为0/8、2/8、5/13、6/10、4/5,组间比较差异有统计学意义（P=0.018）;趋势χ²检验结果提示,随着KLIC评分的增加,DAIR失败率也随之增加,差异有统计学意义（χ²=10.86,P=0.001）。ROC曲线显示KLIC评分在预测DAIR治疗结果上具有较高的准确性（AUC=0.876,95%可信区间0.773~0.978,P<0.001）。Kaplan-Meier曲线提示：KLIC评分≥7分的患者累积治疗成功率低于KLIC评分<7分者,差异有统计学意义（χ²=8.95,P=0.003）。结论 KLIC评分对于DAIR治疗结果具有良好的预测性;对于KLIC评分≥7分的急性PJI患者,DAIR治疗的失败率较高,不建议采用。

A clinical study on the predictive value of preoperative KLIC score for debridement,antibiotic irrigation,and implant retention treatment outcome

Objective To explore KLIC (kidney, liver, index surgery, cemented prosthesis, and C reactive protein value) scoring system to predict the effect of debridement, antibiotic irrigation, and implant retention (DAIR) on acute peripheral prosthesis infection (PJI) accuracy and its clinical significance. Methods Retrospective research was conducted from January 2015 to December 2020. A total of 44 patients (17 males and 27 females) aged 21–86 years, with acute PJI, underwent DAIR at the Department of Orthopedics, Jinling Hospital, Nanjing University School of Medicine. Combined with medical history and test results, the preoperative KLIC score of the patients was calculated, and the patients were divided into five groups according to the following KLIC scores: ≤2, 2.5–3.5, 4–5, 5.5–6.5, and ≥7. The differences in baseline data, length of hospital stay, and DAIR treatment were compared among all groups. Receiver operating characteristic (ROC) curve was used to evaluate the accuracy of the KLIC scoring system in predicting DAIR treatment outcomes. Kaplan-Meier was used to plot the success rate curve of DAIR treatment. Result No significant differences were observed in age, gender, body mass index, lesion site and classification, duration of infection symptoms, and postoperative hospital stay among the five groups (all P values >0.05). The overall cure rate was 61.36% (27/44) and the failure rate was 38.64% (17/44). The failure rates of KLIC score ≤2, 2–3.5, 4–5, 5.5–6.5 and ≥7 were 0/8, 2/8, 5/13, 6/10 and 4/5, respectively, and a significant difference was observed between groups (P=0.018). Chi-square for trend test indicated that the failure rate of DAIR increased with the increase of the KLIC score, and the difference was statistically significant (χ²=10.86, P=0.001). The ROC curve showed that the KLIC score had high accuracy in predicting the DAIR treatment outcome (AUC=0.876, 95% confidence interval, 0.773–0.978, P<0.001). The Kaplan-Meier survival curve suggested that the cumulative treatment success rate of patients with KLIC score ≥7 was lower than that of patients with KLIC score <7, and the difference was statistically significant (χ²=8.95, P=0.003). Conclusion The KLIC score has good predictability for the treatment outcome of DAIR. For patients with acute PJI with a KLIC score ≥7, the failure rate is high and DAIR is not recommended.