Complete Blood Cell Count-Based Ratios Identify Total Joint Arthroplasty Patients Likely to Benefit from Perioperative Dexamethasone.

IF 4.4 1区医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-01-15 Epub Date: 2024-11-20 DOI:10.2106/JBJS.24.00184

Julian Wier, Ian A Jones, Ryan Palmer, Cory K Mayfield, Nicholas J Kassebaum, Jay R Lieberman, Nathanael D Heckmann

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Abstract

Background: Complete blood cell count-based ratios (CBRs), including the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), are inflammatory markers associated with postoperative morbidity. Given the link between the surgical stress response and complications after total joint arthroplasty (TJA), this study aimed to evaluate whether higher preoperative CBR values predict greater postoperative benefits associated with dexamethasone utilization.

Methods: The Premier Healthcare Database was queried for adult patients who underwent primary, elective total hip or knee arthroplasty (THA or TKA). Multivariable logistic regression models using dexamethasone exposure and CBRs as independent variables assessed primary end points of 90-day postoperative complications and length of stay (LOS) of ≥3 days. The probability difference between the dexamethasone and non-dexamethasone groups for each primary end point was determined across all values of each CBR. Probability differences were compared across CBR quartiles.

Results: A total of 32,849 primary, elective TJAs (12,788 THAs [38.93%], 20,061 TKAs [61.07%]) performed between 2016 and 2021 were identified, and 22,282 (67.83%) of the patients received perioperative dexamethasone. Among patients with an NLR value of >1.00, those receiving dexamethasone had a lower probability of postoperative complications (all p < 0.05). Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients in the highest NLR quartile (≥4.67) compared with the lowest quartile (NLR <1.84) (p = 0.002). Among patients with an MLR value of ≥0.36, those receiving dexamethasone had significantly lower odds of postoperative complications. Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients with an MLR of ≥0.33 (the 2 highest quartiles) compared with an MLR of <0.24 (the lowest quartile) (p = 0.039).

Conclusions: Higher NLR and MLR values were associated with greater marginal benefit from perioperative dexamethasone treatment, establishing a modifiable link between adverse outcomes and perioperative inflammation in TJA.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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全血细胞计数为基础的比率确定全关节置换术患者可能受益于围手术期地塞米松。

背景：全血细胞计数比（CBRs），包括中性粒细胞-淋巴细胞比（NLR）和单核细胞-淋巴细胞比（MLR），是与术后发病率相关的炎症标志物。考虑到手术应激反应与全关节置换术（TJA）后并发症之间的联系，本研究旨在评估术前CBR值较高是否预示着地塞米松应用带来更大的术后获益。方法：查询Premier Healthcare数据库中接受过原发性、选择性全髋关节或膝关节置换术（THA或TKA）的成年患者。以地塞米松暴露和cbr为自变量的多变量logistic回归模型评估了术后90天并发症和≥3天住院时间（LOS）的主要终点。每个主要终点的地塞米松组和非地塞米松组之间的概率差异是通过每个CBR的所有值来确定的。在CBR四分位数之间比较概率差异。结果：2016年至2021年共进行了32,849例原发性选择性tja(12,788例tha[38.93%], 20,061例tka[61.07%])，其中22282例（67.83%）患者接受了围手术期地塞米松治疗。NLR值为bbb1.00的患者中，接受地塞米松治疗的患者术后并发症发生率较低（p < 0.05）。与最低四分位数（NLR）相比，最高NLR四分位数（≥4.67）的患者中地塞米松发生≥3天LOS的几率更低。结论：更高的NLR和MLR值与地塞米松围手术期治疗的更大边际效益相关，建立了TJA不良结局与围手术期炎症之间的可修改联系。证据等级：预后III级。有关证据水平的完整描述，请参见作者说明。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.