Acute renal cortical scintigraphy in children with a first urinary tract infection

This prospective study, performed in 101 children with a first symptomatic urinary tract infection (UTI), evaluates the diagnostic value of clinical, biological, and ultrasound parameters in detecting children with acute renal infection documented by dimercaptosuccinic acid (DMSA) scintigraphy. In children with a positive DMSA scan, mean C-reactive protein (CRP) was higher than in children with a normal DMSA scan (114±64 vs. 67±38 mg/dl, mean±SD, P=0.0002). The sensitivity and specificity of CRP was 64% and 68%, respectively. In children with severe kidney involvement, mean CRP and white blood count (WBC) were higher than in children with mild/moderate disease (151±83 vs. 92±55 mg/dl for CRP, P=0.0149; 20,100±6,854 vs. 15,023±6,145 WBC/ mm³ for WBC, P=0.0131). The sensitivity and specificity was 85% and 20% for CRP, and 77% and 18% for WBC, respectively. One or more areas of abnormal cortical echogenicity were documented in 3% of kidneys with positive DMSA scans. Dilatation of the collecting system was observed in 24% of kidneys. The sensitivity and specificity of ultrasonography was 27% and 89%, respectively. In conclusion, clinical, biological, and ultrasound parameters do not accurately distinguish cystitis from pyelonephritis in children with UTI and do not identify children with severe renal damage. Accordingly, we recommend that DMSA scan should be added to the initial work-up of children with UTI. Received: 5 June 2000 / Revised: 9 May 2001 / Accepted: 9 May 2001     

99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings

Seventy-two children, 59 girls and 13 boys, 0.1–15.9 (median 1.1) years of age, with acute pyelonephritis (APN) were investigated with the aid of a dimercaptosuccinic acid (DMSA) scan, renal ultrasonography (US) and a desmopressin test within 5 days of admission. Sixty-two children were reinvestigated approximately 2 months later when intravenous urography (IVU) and micturition cysto-urethrography were also performed. During infection, 92% of the children showed changes in the DMSA scan with 69% by US, and the two investigations agreed in 58% of the kidneys. At follow-up, 68% showed changes in the DMSA scan, 47% by US and 48% by IVU. The DMSA scan and IVU agreed in 60% of the kidneys. Twenty-nine percent of the children had vesico-ureteric reflux (VUR). The presence of grade>-3 VUR was associated with greater defects on the DMSA scan during infection, and at follow-up with a higher frequency of persistent changes compared with no VUR (P<0.02 and 0.01, respectively). During infection the size of the defect on the DMSA scan correlated with renal vooume and C-reactive protein and inversely with the glomerular filtration rate, and at follow-up it correlated inversely with the renal concentration capacity. The DMSA scan is a sensitive method for diagnosing and localizing APN in children, and findings on DMSA scan show a weak but significant correlation with routine clinical and radiological parameters. It is suggested that persistent renal damage after APN in children without VUR may be more common than previously assumed.     

Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection

The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.     

Microsurgical management of postoperative disc space infection

We analysed seventeen patients with septic postoperative spondylodiscitis (POD) who were managed by early microsurgical removal of the infected necrotic tissue, application of a closed suction-irrigation system (for a mean of 6.7 days), and early mobilisation. The POD was diagnosed clinically by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) values and radiographically by computerised tomography scanning or magnetic resonance imaging. According to the sensitivity studies of the obtained pathogens, systemic antibiotics were given, followed by early mobilisation of all patients in a light cast corset. Immediate pain relief was noted in all patients except one, who required a third operation that was followed by rapid clinical improvement. Bacteriological diagnosis was obtained in 88% of the patients. Excellent or good clinical long-term results were achieved in 82% of the patients, whereas 18% had poor results. Elevated ESR/CRP values returned to normal ranges within 6 to 44 days (mean 15 days) after reoperation. All but one patient tolerated early mobilisation (within 2 to 4 weeks) well without any complication. Early microsurgical removal of the necrotic and infected tissue and application of a closed suction-irrigation system supported by specific antibiotic therapy should be considered an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation for the patient.     

Prognostic value of the acute DMSA scan in children with first urinary tract infection

We attempted to verify in a group of 101 children with first urinary tract infection whether it was possible to identify groups of patients with different risks of developing renal scarring by taking into account both the extent of kidney involvement documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesicoureteral reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement) in the presence of VUR or in non-refluxing kidneys was similar (P=0.1447), while the frequency of persistent lesions in kidneys with severe lesions in the presence of VUR was significantly higher than the frequency of persistent lesions in non-refluxing kidneys (P=0.0089). The extent of kidney involvement and the presence of VUR make possible the identification of different categories of risk of scarring: in the ”low risk group” (normal kidney with/without VUR) the risk of scarring is 0%; in the ”intermediate risk group” (mild lesions with/without VUR; extensive lesions without VUR) the risk of scarring is between 14% and 38%, while in the ”high risk group” (extensive lesions with VUR) the risk of scarring is 88%. Quantifying the risk of scarring could help in planning the treatment or in modifying the later strategy. Received: 5 June 2000 / Revised: 23 January 2001 / Accepted: 24 April 2001     

C反应蛋白和血沉联合检测对慢性阻塞性肺疾病并发急性感染的预测价值

目的:探讨联合检测C反应蛋白(CRP)和血沉(ESR)对慢性阻塞性肺疾病(COPD)患者并发感染的早期预测价值.方法:选取COPD患者50例,其中并发急性感染患者38例,未并发感染者12例,23例健康体检者作为健康对照组.分别检测各组人群静脉血CRP和ESR水平,受试者工作特征曲线(ROC曲线)下面积判断CRP和ESR联合检测预测COPD合并急性感染的诊断价值.结果:COPD无感染组及COPD合并感染组患者血清CRP和ESR的水平显著高于健康对照组(P＜0.05);COPD合并感染组CRP和ESR的水平均显著高于COPD无感染组(P＜0.05);以CRP为参考指标(截断值=8.2 mg/L)评估COPD感染的敏感性为97.4％,特异性为90.0％,ROC曲线下面积为0.921 1;以ESR为参考指标(截断值=14.1 mm/1 h)评估COPD感染的敏感性为100.0％,特异性为80.0％,ROC曲线下面积为0.914 5.结论:COPD感染患者CRP和ESR显著升高,联合监测CRP和ESR对COPD患者是否并发感染的早期预测有重要临床价值.     

输注自体血与库存血对患者术后炎症反应的影响

目的探讨输注自体回输血与保存时间短于2周的库存血对患者术后炎症反应的影响。方法选择择期行腰椎滑脱椎弓根内固定植骨融合术手术,估计出血量多于500ml的骨科患者40例。其中20例患者应用自体血回输装置即为回收血组(A组),20例患者单独输注短于2周的库存血即为库存血组(B组)。检测两组患者Hb、Hct、pH、K+、ATP含量和2,3-二磷酸甘油酸(2,3-DPG)及输血后患者的WBC、C-反应蛋白(CRP)、血沉(ESR)。结果 A组患者的pH值、K+、Hct、ATP、2,3-DPG均明显高于B组(P0.05);两组术后1、3dWBC,术后1、3、5dCRP、ESR均明显高于术前(P0.05);术后1、3、5dB组的CRP、ESR均明显高于A组(P0.05)。结论自体血的质量明显优于库存血,输注自体血的患者术后CRP、ESR明显低于输注库存血的患者,提示输注自体血的炎症反应发生率较库存血低。     

Comparison of ultrasound and dimercaptosuccinic acid scintigraphy changes in acute pyelonephritis

 The strategy for morphological investigations in children with acute pyelonephritis (APN) remains debatable. We studied 70 children (median age 2.0 years) admitted with a first episode of pyelonephritis using a high-resolution ultrasound technique (RUS) and compared the results with 99m technetium–dimercaptosuccinic acid (DMSA) renal scintigraphy. The DMSA scan was abnormal in 62 children (89%). However, using a high-frequency transducer we found abnormal sonogram changes in 61 children (87%), consisting of an increased kidney volume in 42, and/or a thickening of the wall of the renal pelvis in 42, and/or a focal hyper- or hypoechogenicity in 36, and/or a diffuse hyperechogenicity in 31 children. Micturating cystourethrography was performed in all children, revealing vesicoureteral reflux (VUR) in 22 (31%). Among those children with VUR, 4 had a normal DMSA scan, 2 an abnormal RUS, and 2 a normal DMSA scan and RUS. Our data suggest that B-mode RUS performed with a high-frequency transducer by a trained radiologist is nearly as sensitive as the DMSA scan in diagnosing renal involvement in children with unobstructed APN and in predicting VUR. Received: 9 January 1998 / Revised: 11 July 1998 / Accepted: 28 July 1998     

Bacterial wound contamination during simple and complex spinal procedures. A prospective clinical study

Background context

Spinal procedures have a potential of intraoperative contamination. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have been used to diagnose postoperative infections after spinal surgery. However, it has not been demonstrated if there is an association between surgical site contamination and clinical manifestation of postoperative infection based on inflammatory markers and patients' clinical course.

Purpose

The purpose of this prospective study was to evaluate the association between surgical site contamination and the development of a postoperative infection in simple and complex surgical procedures. C-reactive protein and ESR levels were observed. The correlation between their values, surgical time, type of surgical procedures, and contaminated surgical sites was investigated.

Study design

Prospective clinical study.

Patient sample

The study consisted of 40 patients divided into two groups. Group A included 20 patients (mean age, 46.2 years; 12 women and 8 men) who underwent an open discectomy for a lumbar herniated disc. Group B consisted of 20 patients (mean age, 67.9 years; 11 women and 9 men) who underwent a decompression and instrumented fusion for lumbar spinal stenosis. They were followed up for an average of 26.7 months (range, 11–40 months).

Outcome measures

Samples were obtained for cultures in standard time intervals during surgery. The types of bacteria cultured were evaluated, and CRP and ESR levels were measured.

Methods

Simple lumbar discectomy (Group A, 20 patients) and instrumented lumbar decompression for degenerative lumbar stenosis (Group B, 20 patients) were performed in a prospective consecutive series of patients. All patients were operated by the same surgeon in the same operating room. Surgical site preparation in each patient was done by a standard manner. Samples were obtained for cultures in standard time intervals during surgery. C-reactive protein and ESR levels were measured preoperatively on the 3rd, 7th, and 21st postoperative days, and the clinical course of each patient was recorded.

Results

From 40 patients, three patients in Group A and five patients in Group B, a total of eight patients (20%) had positive cultures for bacteria. There was no statistical significance between contamination and duration of surgery in both groups. None of the patients with positive intraoperative cultures developed any clinical signs of superficial or deep postoperative spinal infection, and no additional antibiotic treatment was administered. Three patients with negative cultures developed a postoperative infection. There were no differences in CRP and ESR values between patients with contamination and noncontamination in both groups. C-reactive protein and ESR levels were significantly elevated in complex procedures (Group B) than in simple procedures (Group A). Statistical analysis of CRP and ESR values in both groups and types of bacteria cultured intraoperatively are presented.

Conclusions

The results of this study demonstrate that intraoperative contamination can occur during simple and complex spinal procedures. In the absence of postoperative signs of infection in patients with intraoperative contamination, there is no need of continuing antibiotic treatment. Postoperative kinetics of CRP and ESR showed to be the same in patients with and without intraoperative contamination. Higher levels of inflammatory markers were noted in complex spinal procedures where instrumentation was applied.     

术后椎间盘炎的血沉与C反应蛋白分析比较

目的: 探讨腰椎术后椎间隙感染的ESR和CRP特征性改变及早期诊断价值。方法: 回顾 25例行椎板减压髓核摘除术并发椎间隙感染的患者以及前瞻性研究 50例同种手术无感染的患者, 分别于术前、术后 2d、1、2周以及 4周进行ESR和CRP分析对比。结果: 所有患者术后均出现不同程度的ESR和CRP增快, 与术前相比有显著性差异 (P<0. 01), 感染组与非感染组同期比较没有统计学差异 (P>0. 05); 同期CRP与ESR相比, 峰值出现更早, 持续时间更短。结论: 两组ESR和CRP虽没有统计学差异, 但仍是早期诊断椎间盘感染的一种简单、有效和经济的术后常规筛选检查指标, 而且动态监测时间越长, 升高越快, 诊断价值越大。     

粪钙卫蛋白在溃疡性结肠炎活动性分级评价中的临床意义

目的探讨粪钙卫蛋白在溃疡性结肠炎（UC）活动性评价中的临床意义。方法收集2007年9月至2009年12月期间中国医科大学附属第四医院肛肠外科确诊为UC的患者63例及结肠镜检查结果正常但存在相应消化道症状的患者30例,检测并比较其粪钙卫蛋白、红细胞沉降率及C反应蛋白水平。结果活动期Ⅰ、Ⅱ及Ⅲ级组的粪钙卫蛋白和C反应蛋白水平均高于对照组和缓解组（P〈0.05）,且随活动期级别增高,粪钙卫蛋白的水平逐渐增高（P〈0.05）;活动期Ⅱ级及Ⅲ级组的C反应蛋白水平均高于Ⅰ级组（P〈0.05）,但前两者比较差异无统计学意义（P〉0.05）;5组红细胞沉降率比较差异无统计学意义（P〉0.05）。UC活动组的粪钙卫蛋白水平（rs=0.807,P〈0.01）、C反应蛋白水平（rs=0.651,P〈0.01）和红细胞沉降率（rs=0.371,P〈0.05）均与结肠镜下分级相关。结论粪钙卫蛋白可用于评价UC的活动性。由于其检测方法简单、无创、方便及依从性好,具有一定的临床意义。     

脊柱结核手术时机选择的初步研究

目的:观察脊柱结核患者手术前后红细胞沉降率(erythrocyte sedimentation rate,ESR),C-反应蛋白(C-reactive protein,CRP)及神经功能的变化,探讨手术介入时机,评价其对手术安全性的影响.方法:对2012年3月至2017年3月行手术治疗的387例脊柱结核患者进行回顾性分...     

A simple, cost-effective screening protocol to rule out periprosthetic infection

The differential diagnosis of pain after total knee arthroplasty includes infection. Effective screening tools should have high sensitivity and are cost-effective. We evaluated 296 patients who underwent total knee revision at our institution. One hundred sixteen patients (39%) were classified as infected and 180 patients (61%) were considered noninfected. The mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the infected patients were 85 mm/h and 110 mg/L, respectively. The mean ESR and CRP of the noninfected patients were 22 mm/h and 7 mg/L, respectively. Five patients (4%) in the infected group had both normal ESR and CRP. Infection was suspected in all 5 patients, and an organism was cultured in 4 of the 5 cases. Erythrocyte sedimentation rate and CRP, when used in combination, serve as a useful screening tool in patients with a painful total knee arthroplasty.     

Delayed normalization of C-Reactive protein and erythrocyte sedimentation rate was not associated with inferior clinical outcomes after total knee arthroplasty

BackgroundThe purpose of this study aimed to identify the proportion of patients with delayed normalization of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) after TKA, to determine postoperative thresholds predictive of prolonged elevation. Further, we aimed to determine if the clinical outcomes of patients with prolonged elevation were inferior to those without prolonged elevation.MethodsThe records of 211 unilateral and 320 bilateral TKA were reviewed. Patients were divided into the normal and elevation group based on CRP and ESR levels at 6 weeks and 3 months. The temporal pattern of CRP and ESR change in both groups was compared, and thresholds predictive of elevation at 6 weeks and 3 months were identified. Further, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and Tegner activity scale of both groups at 6 months, 1 year, and 2 years after TKA were compared.ResultsThe proportion of patients with elevated CRP and ESR at 6 weeks and 3 months was CRP: 24.2%, 10%, ESR: 51.6%, 29.9% in unilateral and CRP: 31.5%, 10.6%, ESR: 58.1%, 42.7% in bilateral TKA. The thresholds for elevation at 6 weeks and 3 months were 9.5 mg/dL, 11.4 mg/dL (CRP at 6 weeks) and 81.5 mm/h, 74.5 mm/h (ESR at 3 months). There was no difference in the WOMAC score and Tegner activity scale between both groups.ConclusionsCRP and ESR are often elevated for a prolonged period even in the absence of infection after TKA. Such cases show distinct temporal patterns, which are predictable, and do not appear to have a significant effect on clinical outcome     

兔椎间盘炎模型的建立

目的建立椎间盘炎的动物模型。方法采用新西兰大白兔12只,随机分为对照组、实验组,其中对照组4只、实验组8只。将一定量的金黄色葡萄球菌或等量生理盐水注入兔腰椎间隙,术后定期进行磁共振检查及实验区椎间盘组织细菌培养和常规病理学检查,对术后C-反应蛋白（CRP）进行动态观察,并与血沉（ESR）做对照分析。结果一周后注射金黄色葡萄球菌的所有动物均出现椎间盘炎发病,ESR、CRP均明显升高,MRI提示椎间盘炎改变。活检物细菌培养阳性,病理学检查证实有椎间盘炎发生。而注射生理盐水组无椎间盘炎发病。结论将一定量的金黄色葡萄球菌注入兔腰椎间隙可制做椎间盘炎模型,炎症反应明显,模型稳定。可用于人的椎间盘炎的病理学、外科学及药物治疗等多方面的类比实验。     

Normal Range of the Inflammation Related Laboratory Findings and Predictors of the Postoperative Infection in Spinal Posterior Fusion Surgery

Background

Inflammation related hematological parameters vary greatly depending on patients. It is not well known how much increase of which parameter warrants suspicion of postoperative infection. This study proposes to identify the normal range and the predictive factors for postoperative infection by conducting a time series analysis of the hematological parameters of patients after the spinal posterior fusion.

Methods

A retrospective study was done with 608 patients who underwent spinal posterior fusion with pedicle screw fixation. Laboratory assessment including the leucocyte, neutrophil, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) of patients for 2 weeks after operation. The patients were divided into the one-level fusion group (group I), the two-level fusion group (group II), the three or multi-level fusion or reoperation group (group III), and the postoperative infection group (group IV). Blood was drawn before breakfast prior to the operation, and then 2-3 days, 4-7 days, 8-11 days, and 12-14 days after the operation. The leucocyte count, neutrophil count, CRP, and ESR were measured.

Results

From 4-7 days after the operation, the CRP and neutrophil count of group IV were significantly higher than those of group I and II, and from 8-11 days after operation, the CRP and neutrophil counts were significantly higher than those of all groups. Twelve to fourteen days after the operation, the neutrophil count of group IV was significantly higher than that of group I and II, while the neutrophil count of group III was also higher than that of group I. The lower limit of the 95% confidence interval (CI) of the CRP and neutrophil count group IV was greater than the upper limit of the 95% CI of group I and II. The ESR of group IV was significantly higher than that of group I and III.

Conclusions

If the postoperative CRP and neutrophil counts are high, or if the CRP begins to rise again 8 days after the operation, the likelihood of infection increases, but caution must be exercised in interpreting the results. If the hematological parameters are higher than the lower limit of the 95% CI of the postoperative infection group, infection must be strongly suspected.     

Lymphocyte apoptosis after major abdominal surgery is not influenced by anesthetic technique: a comparative study of general anesthesia versus combined general and epidural analgesia

Study ObjectiveTo examine the influence of abdominal colectomy with combined general anesthesia and epidural analgesia versus general anesthesia on apoptosis of circulating lymphocytes.DesignProspective, randomized, clinical comparison study.SettingTertiary-care general hospital.Patients40 ASA physical status I and II patients undergoing elective open colectomy for nonmetastatic colon carcinoma.InterventionsPatients were randomly allocated to two groups to receiver either general anesthesia alone (Group G) or general anesthesia combined with epidural analgesia (Group C). Group C comprised 21 patients while 19 patients constituted Group G. All patients underwent median longitudinal laparotomy.MeasurementsBlood samples were collected preoperatively and 24 hours postoperatively for measurement of lymphocyte apoptosis, serum cortisol, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).Main ResultsThere were no differences between the two groups in age, weight, or duration of surgery. No significant alterations in total lymphocyte counts, as well as in lymphocyte subpopulations (early apoptotic, late apoptotic, viable, and necrotic), were observed between the general and combined anesthesia groups. Cortisol, ESR, and CRP were significantly increased postoperatively in both groups. Group C presented with lower serum cortisol levels postoperatively than Group G (b = ?5.38, CI95%: ?8.72 to ?2.05, P = 0.002).ConclusionsEpidural block could not suppress postoperative lymphocyte apoptosis, increases in cortisol, CRP, or ESR compared with general anesthesia.     

Ultrasonography and erythrocyte distribution width in patients with plantar fasciitis

BackgroundThe measurement of plantar fascia thickness with ultrasonography can be used for both for diagnosis and as a response-to-treatment parameter in plantar fasciitis. Furthermore, with the recent studies, red cell distribution width may be used as an inflammatory marker. Aim of this study is to investigate the association of red cell distribution width and ultrasonography on diagnosis and monitoring of treatment in patients with plantar fasciitis.MethodsClinically diagnosed 102 patients with plantar fasciitis between the dates January 2016 to July 2018 were analysed. Hemogram, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plantar fascial ultrasonography were obtained on initial evaluation and in 1 month, 2 months and 3 months of the standard nonoperative treatment; American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scores were recorded. Posthoc and multivariate logistic regression analysis were used for statistical analysis on SPSS 21.0.ResultsRed cell distribution width was correlated with plantar fascia thickness by the end of the 1 month (r = 0.26, P = .013). Female sex, BMI over 30 kg/m², higher red cell distribution width and higher plantar fascia thickness were associated with plantar fasciitis on initial evaluation. Higher red cell distribution width together with higher plantar fascia thickness were also found to be a risk factor for both on initial evaluation and 1 month after treatment in plantar fasciitis.ConclusionThis study shows that association of red cell distribution width and plantar fascia thickness can be not only a diagnostic predictor but also an indicator of treatment response in plantar fasciitis.Level of clinical evidenceLevel IV     

Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases

Diagnosis of sepsis is difficult, particularly in cases of burn where signs of sepsis may be present in the absence of a real infection. This study compared serum levels of procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) among 60 burned people with and without infection, in order to assess the value of the information for diagnosis of sepsis. A significantly higher PCT level was observed in the septic group compared to those without sepsis (8.45+/-7.8 vs. 0.5+/-1.0, respectively, p<0.001); no significant differences were found in CRP or WBC levels, neutrophil count or ESR. The area under the receiver operating characteristics curve in the diagnosis of sepsis was 0.97 for PCT (p<0.001) with sensitivity of 100% and specificity of 89.3%. Non-survivors had a mean PCT level significantly higher than that of survivors. Thus the serum PCT level was a highly efficient laboratory parameter for the diagnosis of severe infectious complications after burn, but WBC, neutrophil, ESR and CRP levels were of little value.     

术前不明原因C-反应蛋白和红细胞沉降率升高对初次全膝关节置换术后早期假体周围感染的影响

目的 探讨术前不明原因的C-反应蛋白（CRP）和红细胞沉降率（ESR）升高对初次全膝关节置换术（total knee arthroplasty,TKA）术后早期假体周围感染（periprosthetic joint infection,PJI）的影响。方法 回顾性分析2016年11月至2021年10月在我院因膝骨关节炎行TKA治疗的病人,均排除CRP、ESR升高的明显诱因,经纳入和排除标准获得882例,男293例,女589例,年龄为（67.00±7.91）岁（43~98岁）。根据病人术前血CRP和ESR水平将病人分为四组：双阳组44例,CRP阳性组27例,ESR阳性组176例,双阴组635例。评估四组病人行TKA术后90 d内PJI的发生率,通过二元Logistic回归分析CRP和ESR升高的风险因素。结果 双阳组、CRP阳性组、ESR阳性组和双阴组术后90 d内的PJI发生率分别为6.82%（3/44）、0（0/27）、2.27%（4/176）、1.10%（7/635）,四组的感染率比较,差异有统计学意义（P=0.022）。合并糖尿病（OR=2.629,95% CI：1.535~4.502,P＜0.001）和身体质量指数（BMI）高（OR=2.575,95% CI：1.867~3.552,P＜0.001）是术前CRP水平升高的风险因素;女性（OR=2.701,95% CI：1.810~4.031,P＜0.001）、高BMI（OR=1.207,95% CI：2.435~3.942,P＜0.001）和合并糖尿病（OR=1.827,95% CI：1.218~2.739,P=0.004）是术前ESR水平升高的风险因素。结论 术前不明原因CRP和ESR升高增加初次TKA术后90 d内PJI发生风险,应结合性别、BMI、是否合并糖尿病,最后确定能否进行手术,是否需要围术期的额外治疗来预防和降低PJI的发生。