摘要
目的分析布鲁杆菌脊椎炎患者术后住院时间延长的危险因素。方法回顾性分析2011年6月至2021年12月于新疆医科大学第一附属医院脊柱外科接受手术治疗的布鲁杆菌脊椎炎患者130例,男95例、女35例,年龄(51.53±12.26)岁(范围20~76岁)。以患者住院时间的第75%分位数作为临界值,住院时间≥第75%分位数定义为住院时间延长。比较住院时间延长和住院时间正常患者的基线资料、临床结果、实验室检查指标和影像学结果。将两组差异有统计学意义的指标纳入二分类logistic回归分析,确定导致布鲁杆菌脊椎炎术后住院时间延长的独立危险因素。绘制术后住院时间延长的受试者工作特性(receiver operating characteristic,ROC)曲线,计算各独立危险因素的曲线下面积(area under curve,AUC)、95%置信区间(confidence interval,CI)、灵敏度及特异度。结果所有患者均顺利完成手术。住院时间为(6.98±2.73)d(范围6~20 d)。患者住院时间的第75%分位数为9 d,住院时间<9 d为正常住院时间(正常组)、≥9 d为住院时间延长(延长组),其中正常组99例、延长组31例。所有患者均获得随访,随访时间(12.3±3.2)个月(范围7~31个月)。单因素分析结果显示体质指数升高(Z=901.00,P<0.001)、近期消瘦(χ^(2)=15.84,P<0.001)、红细胞沉降率升高(t=-4.82,P<0.001)、C反应蛋白升高(Z=895.50,P<0.001)、白蛋白降低(Z=2199.50,P<0.001)、MRI出现硬膜外脓肿(χ^(2)=10.45,P=0.001)、术中失血量增加(χ^(2)=8.81,P=0.003)可能是导致布鲁杆菌脊椎炎术后住院时间延长的危险因素。二分类logistic回归分析结果显示体质指数升高(OR=1.25,P=0.033)、近期消瘦(OR=0.04,P=3.395)、红细胞沉降率升高(OR=7.50,P<0.001)、C反应蛋白升高(OR=4.71,P=0.008)、MRI出现硬膜外脓肿(OR=3.69,P=0.033)是导致布鲁杆菌脊椎炎术后住院时间延长的独立危险因素,ROC的AUC分别为0.70、0.71、0.71、0.75、0.66,联合预测模型的AUC为0.89,预测价值为良好。结论体质指数升高、近期消瘦、C反应蛋白升高、红细胞沉降率升高、MRI出现硬膜外脓肿是导致布鲁杆菌脊椎炎患者术后住院时间延长的独立危险因素,联合预测模型具有更好的预测效能。
Objective To analyze risk factors for prolonged postoperative hospitalization in patients with Brucella spondylitis(BS).Methods A total of 130 patients with BS who underwent surgical treatment in the Department of Spine Surgery,the First Affiliated Hospital of Xinjiang Medical University from June 2011 to December 2021 were retrospectively analyzed.There were 95 males and 35 females,aged 51.53±12.26 years(range,20-76 years).The 75th percentile of patients'hospitalization time was used as the critical value,and hospitalization time≥75%quartile was defined as prolonged hospitalization time.Baseline data,clinical outcomes,laboratory test indices,and imaging findings were compared between patients with prolonged and normal length of stay.Indicators with statistically significant differences between the two groups were included in a binary logistic regression analysis to determine independent risk factors for prolonged postoperative hospitalization for BS.The receiver operating characteristic(ROC)curve was plotted for subjects with prolonged postoperative hospitalization,and the area under the curve(AUC)for each independent risk factor was calculated.Additionally,95%confidence intervals(CI),sensitivity,and specificity were determined.Results All patients were operated successfully.The length of hospitalization was 6.98±2.73 days(range,6-20 days).The 75%quartile of the length of hospitalization was 9 days,so hospitalization time≤9 days was considered as normal length of hospitalization(normal group)and more than 9 days was considered as prolonged hospitalization(prolonged group),of which there were 99 cases in the normal group and 31 cases in the prolonged group.All patients were followed up for 12.3±3.2 months(range,7-31 months).The results of univariate analysis showed elevated body mass index(Z=901.00,P<0.001),recent wasting(χ^(2)=15.84,P<0.001),elevated erythrocyte sedimentation rate(t=-4.82,P<0.001),elevated C-reactive protein(Z=895.50,P<0.001),decreased albumin(Z=2199.50,P<0.001),presence of epidural abscess on MRI(χ^(2)=10.45,P=0.001),and increased intraoperative blood loss(χ^(2)=8.81,P=0.003)may be risk factors for prolonged hospitalization after BS.Binary logistic regression analysis showed that increased body mass index(OR=1.25,P=0.033),recent wasting(OR=0.04,P=3.395),increased erythrocyte sedimentation rate(OR=7.50,P<0.001),elevated C-reactive protein(OR=4.71,P=0.008),and epidural abscess on MRI(OR=3.69,P=0.033)were independent risk factors for prolonged postoperative hospital stay of BS,and the AUC of ROC was 0.70,0.71,0.71,0.75,0.66,respectively.The AUC of the combined prediction model was 0.89,and the prediction value was good.Conclusion Elevated body mass index,recent wasting,elevated C-reactive protein,elevated erythrocyte sedimentation rate,and the presence of an epidural abscess on MRI are independent risk factors for prolonged postoperative hospitalization in patients with BS,and the combined prediction model has better predictive efficacy.
作者
排尔哈提·亚生
木拉德·买尔旦
盛伟斌
买尔旦·买买提
Parhat·Yasin;Muradil·Mardan;Sheng Weibin;Mardan·Mamat(Department of Spine Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Spine Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200092,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2023年第21期1433-1440,共8页
Chinese Journal of Orthopaedics
