Nomogram prediction of surgical site infection of HIV-infected patients following orthopedic surgery: a retrospective st
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RESEARCH ARTICLE
Open Access
Nomogram prediction of surgical site infection of HIV-infected patients following orthopedic surgery: a retrospective study Rui Ma, Jie He, Biao Xu, Changsong Zhao, Yao Zhang, Xin Li, Sheng Sun and Qiang Zhang*
Abstract Background: Surgical site infection (SSI) is a devastating complication of orthopedic surgery, related with increased morbidity and mortality. This study was performed with the aim to compare the SSI rate in human immunodeficiency virus HIV-positive patients, to identify other risk factors for SSI and to establish a nomogram model to predict the risk of SSI. Methods: A total of 101 HIV-positive individuals following orthopedic surgery patients admitted to Beijing Ditan Hospital. Their characteristics were gathered. The univariate and multiple logistic regression analysis were performed to explore the risk factors of SSI. And the Nomogram prediction model was constructed and verified. Results: The independent predictive factors of SSI included CD4 (Odds ratio [OR], 0.041; P = 0.040), erythrocyte sedimentation rate (ESR) (OR, 89.773; P = 0.030), and procalcitonin (PCT) (OR, 220.746; P = 0.006). The scoring nomogram model was as follows: Logit (SSI) = − 2.63589–0.00314*CD4 < 430.75 = 1) + 0.04695*(ESR < 17.46 = 1) + 2.93694*(PCT < 0.22 = 1). The area under the Receiver Operating Characteristic (ROC) curve was 0.946. The cutoff score was − 2.1026 with a sensitivity of 93.33% and a specificity of 84.88%. Conclusions: CD4, ESR, PCT might affect the occurrence of SSI after orthopedic surgery. The nomogram model constructed in this study is helpful for predicting the probability of SSI. Keywords: Nomogram, Surgical site infection, Orthopedic, HIV, CD4, Erythrocyte sedimentation rate
Introduction Surgical site infection (SSI) is an adverse complication of orthopedic surgery and can increase the risk of readmission [1, 2]. Moreover, SSI often caused poor prognosis, decreased quality of life and the possibility of reoperation [3, 4]. It is well known that HIV patients are more likely to develop SSI than those who are not infected with HIV due to their dramatically decreased CD4 cell count and weak immune resistance [5]. With the extension of HIV infection time, the probability of opportunistic infection * Correspondence: [email protected] Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100015, China
increases greatly, and postoperative orthopedic incision is prone to infection [6]. In clinical orthopedic surgery, internal fixation and implant devices are often used. Due to the body’s autoimmunity rejection of foreign objects, the chance of postoperative wound infection is greatly increased [7]. Internal fixation and implant devices are kept in the body for a long time, creating space and attachments for the growth of pathogens. Therefore, not only does the incidence of SSI increase in the early stage of orthopedic surgery, but it also increases the risk of infection in the later stage. If
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