人工关节感染及其成功治疗对患者报告的生活质量有多大影响?

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Darcie Cooper, Eugene Athan, Piers Yates, Craig Aboltins, Joshua S Davis, Laurens Manning
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引用次数: 0

摘要

背景:无并发症关节置换术可改善疼痛及其他患者报告的结局指标(PROMs),如关节功能评分和生活质量指标。然而,假体周围关节感染(PJI)及其成功治疗对 PROMs 的总体影响尚不明确。在本研究中,我们使用 12 项简表调查第 2 版(SF-12v2)来描述生活质量评分,该调查是一项大型、前瞻性、PJI 观察性研究的一部分。问题/目的:(1)新诊断的 PJI 患者的生活质量评分是否低于一般年龄匹配人群?(2) PJI 患者较低的生活质量评分是否会持续≥ 12 个月? (3) 哪些因素与 12 个月后的良好功能预后相关,良好功能预后的定义是在 SF-12v2 中达到体能部分总分 (PCS) > 50(即高于年龄调整后的人群平均值)或比基线增加 > 8.9 或更多?PIANO(澳大利亚和新西兰假体关节感染观察研究)队列是一项前瞻性、纵向、多中心队列研究,研究对象是2014年7月至2017年12月期间在27个中心招募的783名新诊断PJI患者。所有参与者均接受了为期两年的随访。在诊断时(基线)、诊断后 3 个月、12 个月和 24 个月收集 SF-12v2 评分。治疗成功的定义是:存活且无临床或微生物学感染证据,且未对指数关节持续使用抗生素:在排除了 6.6%(52 人)的死亡患者、4.2%(33 人)髋关节和膝关节以外的其他关节的 PJI 患者以及数据不完整的患者(200 人 [25.5%])后,498 名患者拥有完整的 SF-12v2 数据集。基线时,PCS评分的中位数(IQR)为37(30至46),12个月后增至41(34至49;P<0.001)。这两项指标均低于一般年龄匹配人群的标准值。在 12 个月至 24 个月期间,PCS 分数没有进一步提高。相比之下,基线时 SF-12v2 精神部分总分的中位数(IQR)与年龄调整后的人群标准值(48 [37 至 57])相似。只有 40% 的 PJI 患者在 12 个月时达到了良好的功能预后。在对其他因素进行调整后,PJI 治疗成功后,功能结果良好的几率增加了 67% (95% CI 11% 至 154%; p = 0.02):结论:PJI 对基线 SF-12v2 生活质量测量的 PCS 评分有很大影响,这种影响至少会持续 2 年。成功治疗 PJI 会增加获得良好功能结果的可能性。这些数据可用于设定对PJI患者的期望值,也可用于指导未来的临床研究,将生活质量测量纳入临床终点:二级,治疗性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How Much Does Prosthetic Joint Infection and Its Successful Treatment Affect Patient-reported Quality of Life?

Background: Uncomplicated joint replacement improves pain and other patient-reported outcome measures (PROMs) such as joint function scores and quality-of-life measures. However, the overall impact of periprosthetic joint infection (PJI) and its successful treatment on PROMs is poorly defined. In this study, we describe quality-of-life scores using the 12-item Short Form survey, version 2 (SF-12v2), collected as part of a large, prospective, observational study of PJI.

Questions/purposes: (1) Do patients with newly diagnosed PJI have lower quality-of-life scores than the general age-matched population? (2) Are lower quality-of-life scores for patients with PJI sustained for ≥ 12 months? (3) What factors are associated with a good functional outcome at 12 months, defined by achieving a physical component summary (PCS) score of > 50 on the SF-12v2 (that is, above the age-adjusted population mean) or an increase of > 8.9 or more from baseline?

Methods: The PIANO (Prosthetic joint Infection in Australia and New Zealand, Observational study) cohort was a prospective, longitudinal, multicenter cohort study of 783 patients with newly diagnosed PJI recruited across 27 centers between July 2014 and December 2017. All participants were followed for 2 years. SF-12v2 scores were collected at diagnosis (baseline) and 3, 12, and 24 months after diagnosis. Treatment success was defined as being alive with no clinical or microbiological evidence of infection and no ongoing use of antibiotics for the index joint.

Results: After exclusion of 6.6% (52) who had died, 4.2% (33) with PJI of joints other than hips and knees, and those with incomplete data sets (200 [25.5%]), 498 patients had complete SF-12v2 data sets available. At baseline, the median (IQR) PCS score was 37 (30 to 46), which increased to 41 (34 to 49; p < 0.001) at 12 months. Both measures were lower than those for the general age-matched population norm. There was no further improvement in PCS scores between 12 and 24 months. By contrast, the median (IQR) mental component summary score of the SF-12v2 was similar to age-adjusted population norms (48 [37 to 57]) at baseline. Only 40% of patients with PJI achieved a good functional outcome at 12 months. After adjustment for other factors, treatment success of PJI increased the odds of a good functional outcome by 67% (95% CI 11% to 154%; p = 0.02).

Conclusion: PJIs have a large effect on the PCS score of the SF-12v2 quality-of-life measure at baseline, which is sustained for at least 2 years. Successful treatment of PJI increases the likelihood of a good functional outcome. These data can be used to set expectations for patients presenting with PJI and can be used to inform future clinical studies in which quality-of-life measures are incorporated into clinical endpoints.

Level of evidence: Level II, therapeutic study.

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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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