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Procalcitonin and Neutrophil Lymphocyte Ratio After Spinal Instrumentation Surgery

Inose, Hiroyuki MD, PhD; Kobayashi, Yutaka MD; Yuasa, Masato MD, PhD; Hirai, Takashi MD, PhD; Yoshii, Toshitaka MD, PhD; Okawa, Atsushi MD, PhD

doi: 10.1097/BRS.0000000000003157
CLINICAL CASE SERIES
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Study Design. This was a retrospective observational study.

Objective. To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery.

Summary of Background Data. Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated.

Methods. We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis.

Results. Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688).

Conclusion. Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study.

Level of Evidence: 4

We investigated whether bacterial infection markers are useful predictors of surgical site infection (SSI). Univariate analysis showed that while neutrophil percentage and neutrophil lymphocyte ratio at 6 to 7 days postoperatively were significant predictors for SSI, procalcitonin at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups.

Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.

Address correspondence and reprint requests to Hiroyuki Inose, MD, PhD, Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; E-mail: inose.orth@tmd.ac.jp

Received 27 March, 2019

Revised 16 May, 2019

Accepted 5 June, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.