天然膝部感染性关节炎后的死亡率和不良关节结局：一项接受关节镜冲洗的患者的纵向队列研究。,The Lancet Infectious Diseases

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天然膝部感染性关节炎后的死亡率和不良关节结局：一项接受关节镜冲洗的患者的纵向队列研究。
The Lancet Infectious Diseases ( IF 36.4 ) Pub Date : 2019-12-17 , DOI: 10.1016/s1473-3099(19)30419-0
Simon G F Abram ₁ , Abtin Alvand ₁ , Andrew Judge ₂ , David J Beard ₁ , Andrew J Price ₁

Affiliation

背景技术化脓性关节炎的短期和长期后果是不确定的。我们的目标是确定天然膝部感染性关节炎后的死亡风险和不利的关节结局。方法我们使用国家医院情节统计数据库中的数据，对1997年4月1日至2017年3月31日在英格兰接受了因感染性关节炎而进行关节镜下膝关节冲洗的患者进行了一项回顾性队列研究。排除之前曾在同一膝盖上进行过膝盖手术的患者。确定90天内的死亡率，1年内的不良关节结局（关节置换，截肢，关节置换术）和15年内的关节置换术。初步诊断为败血症性关节炎（ICD-10）的患者的死亡率与败血症性关节炎为次要诊断的患者的死亡率进行了比较。研究结果包括12 132例患者（平均年龄56·6岁[SD 24·9]），其中4307例（36％）为女性。在10 195名（84％）败血症性关节炎为主要入院诊断中，90天死亡率为7·05％（95％CI 6·56-7·57； 719名患者），上升至22·69％（20 ·80-24·68； 418位患者）中的1842位年龄在79岁以上的患者。继发性化脓性关节炎诊断与初次诊断相关，死亡率的调整比值比为2·10（95％CI 1·79-2·46； p <0·0001）。在11 393名至少进行了一年随访的患者中，关节固定的1年发生率为0·13％（95％CI 0·07-0·22； 15例），0·40％（0·30-0 ·54； 46名患者）被截肢，占1·33％；（1·13-1·56； 152例）进行了关节置换术。在15年内，有1816名患者中的159名（8·76％； 95％CI 7·50-10·15）接受了关节置换术，相当于每年置换术的风险约为普通人群的六倍（风险比6·14，95％CI 4·95-7·62； p <0·0001）。解释进行膝关节镜检查的患者，败血性膝关节炎的后果是严重的。这些发现突出了与肌肉骨骼关节感染引起的败血症相关的潜在破坏性后果。资助国立卫生研究院。

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Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout.

BACKGROUND The short-term and long-term consequences of septic arthritis are uncertain. We aimed to determine risk of mortality and adverse joint outcomes following septic arthritis of the native knee. METHODS We did a retrospective cohort study in patients who received arthroscopic knee washout for septic arthritis in England between April 1, 1997, and March 31, 2017, using data in the national Hospital Episode Statistics database. Patients with previous knee surgery to the same knee were excluded. Mortality within 90 days, adverse joint outcomes (arthrodesis, amputation, arthroplasty) within 1 year, and arthroplasty within 15 years were determined. Mortality in patients with a primary admitting diagnosis of septic arthritis (ICD-10) was compared with that in patients in whom septic arthritis was a secondary diagnosis. FINDINGS 12 132 patients were included (mean age 56·6 years [SD 24·9]) of whom 4307 (36%) were female. In 10 195 (84%) patients with septic arthritis as the primary admitting diagnosis, 90-day mortality was 7·05% (95% CI 6·56-7·57; 719 patients), rising to 22·69% (20·80-24·68; 418 patients) in 1842 patients older than 79 years. Secondary septic arthritis diagnosis versus primary diagnosis was associated with an adjusted odds ratio for mortality of 2·10 (95% CI 1·79-2·46; p<0·0001). In 11 393 patients with at least 1 year follow-up, the 1 year rates were 0·13% (95% CI 0·07-0·22; 15 patients) for arthrodesis, 0·40% (0·30-0·54; 46 patients) for amputation, and 1·33%; (1·13-1·56; 152 patients) for arthroplasty. Within 15 years, 159 (8·76%; 95% CI 7·50-10·15) of 1816 patients had received arthroplasty, corresponding to an annual risk of arthroplasty that was about six times that of the general population (risk ratio 6·14, 95% CI 4·95-7·62; p<0·0001). INTERPRETATION The consequences of septic knee arthritis in patients undergoing arthroscopic knee washout are serious. These findings highlight the potentially devastating outcomes associated with sepsis from musculoskeletal joint infection. FUNDING National Institute for Health Research.

更新日期：2020-02-27

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