Correlation between the upregulation of circulating FABP4 and prognosis of joint replacement in patients with osteoarthritis

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Method This study selected patients undergoing THA/TKA aged >18 years who were hospitalized in Anqing First People’s Hospital of Anhui Medical University. A total of 400 patients and 100 healthy subjects were finally included. Based on the results of 90-day follow-up data were included in the complication group, otherwise, they were classified as the no complications group. The demographic and clinical data of the two groups were compared, and the clinical characteristics and risk factors of local complications within 90 days of TKA/THA were evaluated. Results FABP4 concentration (odds ratio (OR)=1.521 95% confidence interval (CI)=1.190–1.944, P =0.001), ASA class (OR=0.064 95% CI=0.005–0.811, P =0.034) and estimated intraoperative blood loss (OR=1.070, 95% CI=1.008–1.135, P=0.027) were found to be predictors of 90-Day Local Complications. Conclusions Higher FABP4 concentration is very common in patients with adverse events occurring locally within the 90 days of TKA/THA and the prevalence of adverse events occurring locally within the 90 days of TKA/THA was higher in patients combined with higher FABP4 concentration, higher ASA class or EIBL. FABP4 concentration, ASA class and EIBL are risk factors for the development of adverse events occurring locally within the 90 days of TKA/THA, but validation in larger sample studies is still needed. 90-day local complications TKA THA FABP4 concentration ASA class Osteoarthritis Figures Figure 1 Figure 2 Figure 3 Introduction Osteoarthritis (OA) is a prevalent joint disorder that predominantly afflicts the elderly, impacting millions of individuals globally. By 2020, OA had ascended to become the fourth leading cause of disability in humans[ 1 ]. The pathological features of OA include the deterioration of joint cartilage and restructuring of subchondral bone, leading to symptoms like joint inflammation, pain, and decreased joint functionality[ 2 ]. The knee and hip joints are primarily affected by OA, with lesser occurrences in the elbow, wrist, shoulder (glenohumeral joint), and ankle joints. Treatment options for OA are currently limited, mainly centered on symptom management. Total hip or knee arthroplasty (THA/TKA) stands out as an effective intervention for managing advanced hip or knee OA[ 3 , 4 ].Overall, THA and TKA show good long-term results, but the recovery process can take weeks to months. Complications may occur during and after arthroplasty, including anaesthesia-related risks, worsening of concomitant disease, adverse drug reactions and allergies, and complications specific to arthroplasty. Fatty Acid Binding Protein (FABP aP2), also referred to as FABP4, is a key fat-related factor predominantly expressed in adipocytes and macrophages[ 5 ]. FABP4 functions as a lipid escort, facilitating the transportation of lipids to specific cellular regions. Previous research indicates that elevated concentrations of FABP4 in the body are linked to conditions such as obesity and metabolic disorders[ 6 – 10 ]. These include type 2 diabetes, atherosclerosis, and coronary heart disease. Furthermore, studies have demonstrated that administering FABP4 inhibitors to mice in animal trials can effectively reduce the risk of joint stiffness. In summary, variations in the concentration levels of FABP4 in the body may play a significant role in OA disease. However, to date, there is a lack of literature investigating the relationship between FABP4 levels and the postoperative prognosis of OA patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) surgeries. Therefore, the purpose of this study is to explore the potential association between FABP4 concentration levels and outcomes following TKA/THA procedures. Our research involves recruiting OA patients who have undergone TKA/THA surgeries as well as healthy individuals for comparison, measuring FABP4 levels in their plasma, and conducting a 90-day postoperative follow-up to assess any complications or adverse events. Materials and methods Participants and collection of blood We enrolled a cohort of 400 patients who underwent TKA or THA surgeries at our hospital between January 2020 and January 2024, along with 100 healthy participants matched during the same period. This study has been approved by our hospital's ethics committee, and all participants have provided signed informed consent. Participants under the age of 18 will be excluded. Additionally, patients with underlying conditions such as liver or kidney diseases, cancer, or incomplete information will also be excluded from the study. To maintain uniformity in assessing patient outcomes, only patients treated by surgeons conducting over 30 procedures per year will be included in the study. We collect patients' basic information and laboratory test results from their medical records during hospitalization, while data for the 90-day follow-up period are retrieved from the outpatient medical records system. We use EDTA anticoagulant tubes to collect fasting venous blood from patients, separate the plasma using a low-temperature centrifugation method, and store it in a -80°C freezer for future use. Determination of FABP4 We will dilute the plasma 20 times and use an ELISA kit to detect the plasma concentration of FABP4. Outcome Assessment As in the previous study, the primary outcome (locally within the 90 days) was defined as any of the following: reoperation, readmission, venous thromboembolism, pulmonary embolism, blood transfusion, peripheral nerve injury, and surgical site infection. Statistical analyses We will conduct statistical analysis using IBM SPSS Statistics 26.0. For quantitative parameters, we will report the mean ± standard deviation and use the Student's t-test or the Mann-Whitney nonparametric test to compare differences between groups. Qualitative parameters will be reported in percentage form and compared using the chi-square test. Multiple regression analysis will be performed to determine the risk factors for locally within the 90 days after THA/TKA surgery. Receiver Operating Characteristic (ROC) curve analysis will be used to determine the sensitivity, specificity, area under the curve (AUC), and risk factors for locally within the 90 days after THA/TKA surgery. A p-value less than 0.05 will be considered statistically significant. Results Plasma FABP4 was closely associated with OA After an initial screening of 454 patients with OA and 100 healthy subjects, a total of 400 patients were included in the analysis following exclusions, as depicted in Fig. 1 . Based on their plasma FABP4 concentrations, the patients were categorized into a low expression group, consisting of 265 patients, and a high expression group, consisting of 135 patients. Within the primary cohort, 24 patients (6.0%) experienced at least one locally within the 90 days. Elevated plasma FABP4 concentrations were observed in OA patients compared to healthy subjects (20.5 ± 9.8 ng/ml vs. 12.2 ± 3.1 ng/ml, p < 0.001), as demonstrated in Fig. 2 Clinical significance of FABP4 in OA patients In order to further investigate the clinical relevance of FABP4 in OA, the correlation between FABP4 levels and clinicopathological characteristics was examined. Patients were categorized into two groups according to their plasma FABP4 levels. It was observed that low FABP4 expression was significantly associated with BMI (P = 0.001). No significant correlations were found between FABP4 and other clinicopathological variables, including gender, age, white blood cell count, neutrophil count, mononuclear leucocyte count, D-dimer levels, C-reactive protein levels, total cholesterol levels, triglyceride levels, and the presence of complications (Table 1 ). Table 1 Correlation between the expression of FABP4 and clinicopathological characteristics Variables Number FABP4,n(%) P-value Low expression High expression Gender Male 381 251(98.04) 130(74.81) 0.439 Female 19 14(1.96) 5(25.19) Age < 60 263 166(62.64) 97(71.85) 0.160 ≥ 60 137 90(37.36) 38(28.15) BMI Thin 22 10(3.77) 12(8.89) 0.001 normal 183 138(52.07) 45(33.33) overweight 195 117(44.16) 78(57.78) white blood cell Normal 191 135(50.94) 56(41.48) 0.073 High 209 130(49.06) 79(58.52) Neutrophil Normal 219 152(57.36) 67(49.63) 0.142 High 181 113(42.64) 68(50.37) Mononuclear leucocyte Normal 186 118(44.52) 88(65.18) 0.268 High 214 147(55.48) 47(34.82) D-dimer Normal 235 157(59.24) 78(57.78) 0.778 High 165 108(40.76) 57(42.22) C-reactive protein Normal 264 168(63.39) 96(71.11) 0.124 High 136 97(36.61) 39(28.89) Total Cholesterol Normal 196 129(48.68) 67(49.63) 0.857 High 204 136(51.32) 68(50.37) Triglycerides normal 209 134(50.57) 75(55.55) 0.345 High 191 131(49.43) 60(44.45) Complication hypertensio Yes 123 88(33.21) 35(25.92) 0.136 No 277 177(66.79) 100(74.08) diabetes Yes 125 79(29.81) 46(34.07) 0.384 No 275 186(70.19) 89(65.93) coronary heart disease Yes 177 124(46.79) 53(39.26) 0.151 no 223 141(53.21) 82(60.74) Abbreviations: BMI: Body mass index; Characteristics of after 90-day follow-up data 90-day follow-up parameters of no complications patients and complications patients are summarized in Table 2 . Compared to no complications patients, complications patients had significantly higher BMI (27.10 ± 2.19 vs. 22.95 ± 2.90; P = 0.033), FABP4 concentration (20.0 ± 5.74 vs. 12.6 ± 3.04; P < 0.001), ASA class(P < 0.001), operative time (P < 0.001) and estimated intraoperative blood loss (EIBL) (263.09 ± 58.02 vs. 174.15 ± 41.80; P = 0.001). No significant variances were observed in comorbidities, total cholesterol (P = 0.170), triglycerides (P = 0.290), and other variables between the two groups. Table 2 Patient and Clinicopathologic Characteristics of the no complications and complications Characteristic No complications(n = 376) Complications(n = 24) P-value Age, year 67.46 ± 9.41 70.88 ± 9.31 0.605 Sex Male 359(95.48) 22(91.67) 0.395 Female 17(4.52) 2(8.33) Primary diagnosis OA 360(95.74) 21(87.5) 0.066 RA and others 16(4.26) 3(12.5) BMI 22.95 ± 2.90 27.10 ± 2.19 0.033 BSA 1.67 ± 0.14 1.72 ± 0.16 0.393 white blood cell, 10^9/L 5.50 ± 1.11 6.10 ± 1.19 0.844 Hemoglobin, g/L 154.2 ± 10.26 153.2 ± 7.99 0.242 platelet count, 10^9/L 232.2 ± 35.20 239.1 ± 28.08 0.257 Serum albumin, g/dL 48.64 ± 2.19 49.04 ± 2.28 0.752 D-dimer Normal 220(58.51) 15(62.5) 0.700 High 156(41.49) 9(37.5) FABP4 concentration, ng/ml 12.6 ± 3.04 20.0 ± 5.74 < 0.001 Osteoporosis Yes 7(1.86) 1(4.17) 0.434 no 369(98.14) 23(95.83) ASA class ≥ 3 18(4.79) 20(83.33) < 0.001 ≤ 2 358(95.21) 4(16.67) Anesthesia general 24(6.38) 3(12.5) 0.247 intraspinal 352(93.62) 21(87.5) Operative time, min ≤ 150 351(93.35) 13(54.17) 150 25(6.65) 11(45.83) EIBL, mL 174.15 ± 41.80 263.09 ± 58.02 0.001 Lowest heart rate, bpm 62.06 ± 8.76 60.20 ± 9.37 0.902 Lowest MAP, mmHg 106.21 ± 13.54 110.86 ± 13.80 0.889 Smoking habit Yes 178(47.34) 13(54.17) 0.516 no 198(52.66) 11(45.83) Alcohol drinking habit yes 209(55.59) 9(37.5) 0.085 no 167(44.41) 15(62.5) comorbidity Hypertension Yes 114(30.32) 9(37.5) 0.460 No 262(69.68) 15(62.5) Diabetes mellitus Yes 117(31.12) 8(33.33) 0.820 No 259(68.89) 16(66.67) dyslipidemia Yes 134(35.63) 8(33.33) 0.819 No 242(64.36) 16(66.67) coronary heart disease Yes 166(44.15) 11(45.83) 0.872 no 210(55.85) 13(54.17) AST(IU/L) 19.5 ± 6.68 17.4 ± 5.55 0.345 ALT(IU/L) 22.76 ± 5.88 20.1 ± 4.04 0.066 Blood urea nitrogen (mg/dL) 15 ± 3.93 15 ± 4.12 0.453 eGFR(ml/min/1.73m 2 ) 79.2 ± 12.95 78.3 ± 17.30 0.149 Total cholesterol(mmol/L) 4.23 ± 0.64 4.19 ± 0.53 0.170 LDL cholesterol(mmol/L) 2.39 ± 0.54 2.34 ± 0.38 0.057 HDL cholesterol (mmol/L) 1.25 ± 0.31 1.07 ± 0.28 0.696 Triglycerides (mmol/dL) 1.20 ± 0.16 1.17 ± 0.15 0.290 Table 3 Results of Univariable Logistic Regression for Prediction of 90-Day Local Complications Variable Prediction model, OR(95% CI) P value BMI 1.885(0.917–3.872) 0.084 FABP4 concentration 1.521(1.190–1.944) 0.001 ASA class ≥ 3 0.064(0.005–0.811) 0.034 ≤ 2 1.00(reference) - Operative time, min ≤ 150 1.00(reference) - > 150 4.001(0.027-597.837) 0.587 EIBL 1.070(1.008–1.135) 0.027 Variables are expressed as number (%), means ± SD or medians (interquartile ranges) Multiple logistic regression analysis of factors associated with the occurrence of complications after 90-day follow-up Based on the stepwise multiple logistic regression analysis involving BMI, FABP4 concentration, ASA class, operative time, and EIBL, the study identified the following factors associated with 90 days Localized complications: FABP4 concentration (odds ratio [OR] = 1.521, 95% confidence interval [CI] = 1.190–1.944, P = 0.001) ASA class (OR = 0.064, 95% CI = 0.005–0.811, P = 0.034) EIBL (OR = 1.070, 95% CI = 1.008–1.135, P = 0.027) The ROC curves for FABP4 concentration, ASA class, and EIBL in predicting 90 days Localized complications are depicted in Fig. 3 . Discussion TKA or THA can significantly improve patients' quality of life and restore joint function[ 11 ]. The long-term efficacy of joint prostheses can reach up to 90% over 15 years. Due to its cost-effectiveness, TKA and THA procedures have seen an increasing trend annually, becoming the gold standard treatment for end-stage severe osteoarthritis[ 12 ]. However, the first 90 days post-surgery are a high-risk period for complications such as postoperative infections and peripheral neuritis. These unexpected complications can prolong hospital stays, increase healthcare costs, and in severe cases, impact patients' postoperative recovery, leading to disability or death[ 13 , 14 ]. Therefore, controlling the occurrence of postoperative complications is crucial for evaluating postoperative outcomes and the quality of care. This study aims to explore the potential impact of a novel adipokine, FABP4, on the prognosis after TKA or THA. The research findings indicate that the concentration levels of FABP4 in the body are associated with the incidence of postoperative complications. FABP4 is a protein widely expressed in adipocytes and macrophages, first discovered in adipose tissue and mature fat cells in the 1980s. As a key regulator of lipid metabolism, FABP4 plays a crucial role in the body's metabolic processes. Its main functions include regulating lipid metabolism and inflammatory responses, which significantly influence the transport and utilization of fatty acids in the body. Studies have shown that elevated levels of FABP4 may be associated with an increased risk of metabolic diseases such as insulin resistance, type 2 diabetes, and atherosclerosis. Experimental evidence indicates that the FABP4 molecule directly impacts various cell types, including hepatocytes, macrophages, cardiomyocytes, vascular endothelial cells, and vascular smooth muscle cells. Despite some advances in research, the specific mechanisms of action of FABP4 and its potential receptors remain areas for further exploration. Therefore, FABP4 may play a crucial regulatory role in disease development, either by indirectly exacerbating traditional risk factors or by directly interfering with the metabolic processes in patients, leading to potential increased risks. Further studies on the mechanisms of action of FABP4 and its specific roles in metabolic diseases will contribute to a deeper understanding of its potential pathophysiological functions. In this study, the researchers discovered that the levels of FABP4 concentration within the body, ASA classification, and intraoperative EIBL were linked to the occurrence of early postoperative complications in patients undergoing TKA and THA. Despite the data originating solely from patients at a single medical facility, the varied sources of patients and the adequate sample size ensured the representation and applicability of the study outcomes. By utilizing multivariate logistic analysis, the researchers isolated FABP4 concentration, ASA classification, and EIBL as autonomous prognostic elements. When compared to the approach of single-variable analysis for selecting forecasting elements, the multivariate analysis not only outperforms but also integrates these elements to more precisely forecast the likelihood of postoperative complications. These results align with prior investigations and deepen our comprehension of how these prognostic factors contribute to postoperative complications[ 13 , 14 ]. Based on our knowledge, we are the first to investigate the correlation between intra-body concentration levels of FABP4 and postoperative complications following TKA or THA surgeries. However, we must acknowledge that the study has certain limitations. Firstly, since we only included Chinese patients, the generalizability to other ethnic groups remains to be validated. Secondly, despite adhering to predefined inclusion and exclusion criteria, the retrospective nature of the study may introduce some degree of selection bias. Lastly, the TKA/THA surgeries in our study were performed by multiple different surgeons, potentially leading to variations in surgical techniques. To enhance the reliability of our findings, we are actively expanding our recruitment scope to cover diverse geographical regions and clinical settings, and considering incorporating additional variables for future analyses. Conclusion Higher FABP4 concentration is very common in patients with adverse events occurring locally within the 90 days of TKA/THA and the prevalence of adverse events occurring locally within the 90 days of TKA/THA was higher in patients combined with higher FABP4 concentration, higher ASA class or EIBL. FABP4 concentration, ASA class and EIBL are risk factors for the development of adverse events occurring locally within the 90 days of TKA/THA, but validation in larger sample studies is still needed. Abbreviations AUC area under the curve AST aspartate transaminase, ALT alanine transaminase, CI confidence interval EIBL estimated intraoperative blood loss eGFR estimated glomerular filtration rate, FABP Fatty Acid Binding Protein HDL high-density lipoprotein, LDL low-density lipoprotein, MAP mean arterial pressure, OR odds ratio OA Osteoarthritis ROC receiver operating characteristic THA total hip arthroplasty TKA total knee arthroplasty Declarations Acknowledgements We are particularly grateful to all the people who have given us help on our Article. Author contributions Conception and design of the research: Silong Lin, Xianqi Zhang; Acquisition of data: Xishang Xia; Analysis and interpretation of the data: Xishang Xia 1 , Guishui Xu; Statistical analysis: Xianqi Zhang, Hong Pan; Obtaining financing: Hong Pan; Writing of the manuscript: Silong Lin; Critical revision of the manuscript for intellectual content: Xianqi Zhang, Xishang Xia, Guishui Xu, Hong Pan; All authors read and approved the final draft Funding This study was supported by university-level scientific research program of South Anhui Medical College (JXYY202278) and Anhui Medical University Research Fund (2022XKJ094). Data availability All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author Disclosure The authors declare that they have no conflicts of interest regarding this work. Ethics approval and consent to participate This study has been approved by Ethics Committee of Anqing First People’s Hospital of Anhui Medical University, and all participants have provided signed informed consent. Author details 1 Orthopedic surgery, Anqing First People’s Hospital of Anhui Medical University, Anqing 246003, Anhui province, China References César Fernández-de-Las-Peñas, Lidiane L Florencio , Ana I de-la-Llave-Rincón, Ricardo Ortega-Santiago , Margarita Cigarán-Méndez, Stella Fuensalida-Novo, Gustavo Plaza-Manzano , Lars Arendt-Nielsen , Juan A Valera-Calero, Marcos J Navarro-Santana . Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review. J Clin Med. 2023 Oct 19;12(20):6624. Samuel Joshua Pragasam Sampath, Vijayalakshmi Venkatesan, Sudip Ghosh, Nagasuryaprasad Kotikalapudi. Obesity, Metabolic Syndrome, and Osteoarthritis-An Updated Review. Curr Obes Rep. 2023 Sep;12(3):308-331. LROI. Online LROI-report 2018 2018 [Available from: https://www.lroi-report.nl/previous-reports/online-lroi-report-2018/. OECD. Health at a Glance 2017: OECD Indicators, OECD Publishing; 2017 [Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en;jsessionid=sHVPNloegsvfCp0tRJdc6BR7.ip-10-240-5-110 Yue Shi , Chi-Chiu Wang , Liqun Wu , Yunqing Zhang , Aimin Xu, Yao Wang . Pathophysiological Insight into Fatty Acid-Binding Protein-4: Multifaced Roles in Reproduction, Pregnancy, and Offspring Health. Int J Mol Sci. 2023 Aug 10;24(16):12655 Rahul Mallick , Sanjay Basak , Ranjit K Das , Antara Banerjee , Sujay Paul , Surajit Pathak , Asim K Duttaroy . Fatty Acids and their Proteins in Adipose Tissue Inflammation. Cell Biochem Biophys. 2024 Mar;82(1):35-51. Ellen M van der Ark-Vonk , Mike V Puijk , Gerard Pasterkamp , Sander W van der Laan . The Effects of FABP4 on Cardiovascular Disease in the Aging Population. Curr Atheroscler Rep. 2024 May;26(5):163-175. Kacey J Prentice , Alexandra Lee , Paulina Cedillo , Karen E Inouye , Meric Erikci Ertunc , Jillian K Riveros , Grace Yankun Lee , Gökhan S Hotamisligil . Sympathetic tone dictates the impact of lipolysis on FABP4 secretion. J Lipid Res. 2023 Jun;64(6):100386. doi: 10.1016/j.jlr.2023.100386. Piyas Gargari, Pradip Mukhopadhyay, Banshi Saboo, Anoop Misra, Sujoy Ghosh . Fabkin and glucose homeostasis. Am. J. Cardiol. 106(8), 1118–1123 (2010). Antwi-Boasiako Oteng , Sander Kersten . Mechanisms of Action of trans Fatty Acids. Diabetes Metab Syndr. 2022 Aug;16(8):102565. Matthew B Shirley , Michael B Stuart , Matthew R Claxton , Paul L Sousa et al , Contemporary Outcomes of Transfemoral Amputation After Total Knee Arthroplasty. J Arthroplasty. 2022 Jul;37(7):1359-1363. Christopher Fenelon, Evelyn P Murphy , Eoin J Fahey , Robert P Murphy , Niamh M O'Connell , Joseph M Queally et al . Total Knee Arthroplasty in Hemophilia: Survivorship and Outcomes-A Systematic Review and Meta-Analysis. J Arthroplasty. 2022 Mar;37(3):581-592.e1. Erica J Weinstein, Alisa J Stephens-Shields , Craig W Newcomb , Randi Silibovsky , Charles L Nelson et al. Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty. JAMA Netw Open. 2023 Oct 2;6(10):e2340457 Kosuke Inoue, Daniel M Blumenthal, David Elashoff, Yusuke Tsugawa et al. Association between physician characteristics and payments from industry in 2015-2017: observational study. BMJ Open. 2019 Sep 20;9(9):e031010 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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07:53:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4699232/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4699232/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62157899,"identity":"0d51ff06-a10b-4876-a1b5-d6afd5b11895","added_by":"auto","created_at":"2024-08-09 21:24:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68018,"visible":true,"origin":"","legend":"\u003cp\u003eEnrollment of the study participants in the primary cohort.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4699232/v1/cd8947839cc17badc321dade.png"},{"id":62157898,"identity":"b2725137-8815-43c2-8354-7981068869b3","added_by":"auto","created_at":"2024-08-09 21:24:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10619,"visible":true,"origin":"","legend":"\u003cp\u003eFABP4 concentrations of plasma samples from osteoarthritis patients and healthy controls.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4699232/v1/bb16709a6b0d28efd30b2e05.png"},{"id":62157900,"identity":"112b9ba9-cc10-4b69-8bbc-1e249dd0bf5b","added_by":"auto","created_at":"2024-08-09 21:24:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":17186,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of amphiregulin with other indicators, such as FABP4 concentration, ASA class and EIBL for the diagnosis of 90-Day Local Complications by areas under the receiver operating curves (AUROCs)\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4699232/v1/5597279384a5d772ecf6fdff.png"},{"id":62234354,"identity":"96019e42-73fc-4f9d-aff8-d735edce32aa","added_by":"auto","created_at":"2024-08-11 23:42:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":768419,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4699232/v1/82d0508c-e1bb-4dfe-8aac-4cd26c78a2f1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation between the upregulation of circulating FABP4 and prognosis of joint replacement in patients with osteoarthritis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteoarthritis (OA) is a prevalent joint disorder that predominantly afflicts the elderly, impacting millions of individuals globally. By 2020, OA had ascended to become the fourth leading cause of disability in humans[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The pathological features of OA include the deterioration of joint cartilage and restructuring of subchondral bone, leading to symptoms like joint inflammation, pain, and decreased joint functionality[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The knee and hip joints are primarily affected by OA, with lesser occurrences in the elbow, wrist, shoulder (glenohumeral joint), and ankle joints. Treatment options for OA are currently limited, mainly centered on symptom management. Total hip or knee arthroplasty (THA/TKA) stands out as an effective intervention for managing advanced hip or knee OA[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Overall, THA and TKA show good long-term results, but the recovery process can take weeks to months. Complications may occur during and after arthroplasty, including anaesthesia-related risks, worsening of concomitant disease, adverse drug reactions and allergies, and complications specific to arthroplasty.\u003c/p\u003e \u003cp\u003eFatty Acid Binding Protein (FABP aP2), also referred to as FABP4, is a key fat-related factor predominantly expressed in adipocytes and macrophages[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. FABP4 functions as a lipid escort, facilitating the transportation of lipids to specific cellular regions. Previous research indicates that elevated concentrations of FABP4 in the body are linked to conditions such as obesity and metabolic disorders[\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These include type 2 diabetes, atherosclerosis, and coronary heart disease. Furthermore, studies have demonstrated that administering FABP4 inhibitors to mice in animal trials can effectively reduce the risk of joint stiffness.\u003c/p\u003e \u003cp\u003eIn summary, variations in the concentration levels of FABP4 in the body may play a significant role in OA disease. However, to date, there is a lack of literature investigating the relationship between FABP4 levels and the postoperative prognosis of OA patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) surgeries. Therefore, the purpose of this study is to explore the potential association between FABP4 concentration levels and outcomes following TKA/THA procedures. Our research involves recruiting OA patients who have undergone TKA/THA surgeries as well as healthy individuals for comparison, measuring FABP4 levels in their plasma, and conducting a 90-day postoperative follow-up to assess any complications or adverse events.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and collection of blood\u003c/h2\u003e \u003cp\u003e We enrolled a cohort of 400 patients who underwent TKA or THA surgeries at our hospital between January 2020 and January 2024, along with 100 healthy participants matched during the same period. This study has been approved by our hospital's ethics committee, and all participants have provided signed informed consent.\u003c/p\u003e \u003cp\u003eParticipants under the age of 18 will be excluded. Additionally, patients with underlying conditions such as liver or kidney diseases, cancer, or incomplete information will also be excluded from the study. To maintain uniformity in assessing patient outcomes, only patients treated by surgeons conducting over 30 procedures per year will be included in the study.\u003c/p\u003e \u003cp\u003eWe collect patients' basic information and laboratory test results from their medical records during hospitalization, while data for the 90-day follow-up period are retrieved from the outpatient medical records system. We use EDTA anticoagulant tubes to collect fasting venous blood from patients, separate the plasma using a low-temperature centrifugation method, and store it in a -80\u0026deg;C freezer for future use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDetermination of FABP4\u003c/h2\u003e \u003cp\u003eWe will dilute the plasma 20 times and use an ELISA kit to detect the plasma concentration of FABP4.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOutcome Assessment\u003c/h2\u003e \u003cp\u003eAs in the previous study, the primary outcome (locally within the 90 days) was defined as any of the following: reoperation, readmission, venous thromboembolism, pulmonary embolism, blood transfusion, peripheral nerve injury, and surgical site infection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eWe will conduct statistical analysis using IBM SPSS Statistics 26.0. For quantitative parameters, we will report the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and use the Student's t-test or the Mann-Whitney nonparametric test to compare differences between groups. Qualitative parameters will be reported in percentage form and compared using the chi-square test. Multiple regression analysis will be performed to determine the risk factors for locally within the 90 days after THA/TKA surgery. Receiver Operating Characteristic (ROC) curve analysis will be used to determine the sensitivity, specificity, area under the curve (AUC), and risk factors for locally within the 90 days after THA/TKA surgery. A p-value less than 0.05 will be considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003ePlasma FABP4 was closely associated with OA\u003c/h2\u003e\n \u003cp\u003eAfter an initial screening of 454 patients with OA and 100 healthy subjects, a total of 400 patients were included in the analysis following exclusions, as depicted in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Based on their plasma FABP4 concentrations, the patients were categorized into a low expression group, consisting of 265 patients, and a high expression group, consisting of 135 patients. Within the primary cohort, 24 patients (6.0%) experienced at least one locally within the 90 days. Elevated plasma FABP4 concentrations were observed in OA patients compared to healthy subjects (20.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8 ng/ml vs. 12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 ng/ml, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as demonstrated in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eClinical significance of FABP4 in OA patients\u003c/h2\u003e\n \u003cp\u003eIn order to further investigate the clinical relevance of FABP4 in OA, the correlation between FABP4 levels and clinicopathological characteristics was examined. Patients were categorized into two groups according to their plasma FABP4 levels. It was observed that low FABP4 expression was significantly associated with BMI (P\u0026thinsp;=\u0026thinsp;0.001). No significant correlations were found between FABP4 and other clinicopathological variables, including gender, age, white blood cell count, neutrophil count, mononuclear leucocyte count, D-dimer levels, C-reactive protein levels, total cholesterol levels, triglyceride levels, and the presence of complications (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation between the expression of FABP4 and clinicopathological characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFABP4,n(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow expression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh expression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251(98.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130(74.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(25.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166(62.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97(71.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90(37.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(28.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(8.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138(52.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117(44.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(57.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ewhite blood cell\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135(50.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56(41.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130(49.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(58.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eNeutrophil\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152(57.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67(49.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113(42.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68(50.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eMononuclear leucocyte\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118(44.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(65.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e147(55.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(34.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eD-dimer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157(59.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(57.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108(40.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57(42.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eC-reactive protein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168(63.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96(71.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97(36.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39(28.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eTotal Cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129(48.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67(49.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136(51.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68(50.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eTriglycerides\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134(50.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75(55.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131(49.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60(44.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ehypertensio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(33.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(25.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e177(66.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100(74.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ediabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(29.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(34.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e186(70.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89(65.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ecoronary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124(46.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53(39.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141(53.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82(60.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eAbbreviations: BMI: Body mass index;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eCharacteristics of after 90-day follow-up data\u003c/h2\u003e\n \u003cp\u003e90-day follow-up parameters of no complications patients and complications patients are summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. Compared to no complications patients, complications patients had significantly higher BMI (27.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19 vs. 22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90; P\u0026thinsp;=\u0026thinsp;0.033), FABP4 concentration (20.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74 vs. 12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ASA class(P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), operative time (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and estimated intraoperative blood loss (EIBL) (263.09\u0026thinsp;\u0026plusmn;\u0026thinsp;58.02 vs. 174.15\u0026thinsp;\u0026plusmn;\u0026thinsp;41.80; P\u0026thinsp;=\u0026thinsp;0.001). No significant variances were observed in comorbidities, total cholesterol (P\u0026thinsp;=\u0026thinsp;0.170), triglycerides (P\u0026thinsp;=\u0026thinsp;0.290), and other variables between the two groups.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePatient and Clinicopathologic Characteristics of the no complications and complications\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo complications(n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eComplications(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.46\u0026thinsp;\u0026plusmn;\u0026thinsp;9.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.88\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e359(95.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(91.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(8.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePrimary diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e360(95.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRA and others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(4.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewhite blood cell, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemoglobin, g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e154.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eplatelet count, 10^9/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e232.2\u0026thinsp;\u0026plusmn;\u0026thinsp;35.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e239.1\u0026thinsp;\u0026plusmn;\u0026thinsp;28.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum albumin, g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eD-dimer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e220(58.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156(41.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFABP4 concentration, ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eOsteoporosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(4.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e369(98.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(95.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eASA class\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(4.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(83.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e358(95.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAnesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(6.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eintraspinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e352(93.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eOperative time, min\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e351(93.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(54.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(6.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(45.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEIBL, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e174.15\u0026thinsp;\u0026plusmn;\u0026thinsp;41.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e263.09\u0026thinsp;\u0026plusmn;\u0026thinsp;58.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLowest heart rate, bpm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.06\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.20\u0026thinsp;\u0026plusmn;\u0026thinsp;9.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLowest MAP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110.86\u0026thinsp;\u0026plusmn;\u0026thinsp;13.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSmoking habit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178(47.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(54.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198(52.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(45.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAlcohol drinking habit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209(55.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e167(44.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecomorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114(30.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e262(69.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117(31.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e259(68.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003edyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134(35.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e242(64.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ecoronary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166(44.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(45.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210(55.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(54.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST(IU/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT(IU/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood urea nitrogen (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeGFR(ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal cholesterol(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL cholesterol(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL cholesterol (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriglycerides (mmol/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of Univariable Logistic Regression for Prediction of 90-Day Local Complications\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePrediction model, OR(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.885(0.917\u0026ndash;3.872)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFABP4 concentration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.521(1.190\u0026ndash;1.944)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.064(0.005\u0026ndash;0.811)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperative time, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.001(0.027-597.837)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEIBL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.070(1.008\u0026ndash;1.135)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eVariables are expressed as number (%), means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or medians (interquartile ranges)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eMultiple logistic regression analysis of factors associated with the occurrence of complications after 90-day follow-up\u003c/h2\u003e\n \u003cp\u003eBased on the stepwise multiple logistic regression analysis involving BMI, FABP4 concentration, ASA class, operative time, and EIBL, the study identified the following factors associated with 90 days Localized complications:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eFABP4 concentration (odds ratio [OR]\u0026thinsp;=\u0026thinsp;1.521, 95% confidence interval [CI]\u0026thinsp;=\u0026thinsp;1.190\u0026ndash;1.944, P\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eASA class (OR\u0026thinsp;=\u0026thinsp;0.064, 95% CI\u0026thinsp;=\u0026thinsp;0.005\u0026ndash;0.811, P\u0026thinsp;=\u0026thinsp;0.034)\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003cul\u003e\n \u003cli\u003eEIBL (OR\u0026thinsp;=\u0026thinsp;1.070, 95% CI\u0026thinsp;=\u0026thinsp;1.008\u0026ndash;1.135, P\u0026thinsp;=\u0026thinsp;0.027)\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThe ROC curves for FABP4 concentration, ASA class, and EIBL in predicting 90 days Localized complications are depicted in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTKA or THA can significantly improve patients' quality of life and restore joint function[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The long-term efficacy of joint prostheses can reach up to 90% over 15 years. Due to its cost-effectiveness, TKA and THA procedures have seen an increasing trend annually, becoming the gold standard treatment for end-stage severe osteoarthritis[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the first 90 days post-surgery are a high-risk period for complications such as postoperative infections and peripheral neuritis. These unexpected complications can prolong hospital stays, increase healthcare costs, and in severe cases, impact patients' postoperative recovery, leading to disability or death[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, controlling the occurrence of postoperative complications is crucial for evaluating postoperative outcomes and the quality of care. This study aims to explore the potential impact of a novel adipokine, FABP4, on the prognosis after TKA or THA. The research findings indicate that the concentration levels of FABP4 in the body are associated with the incidence of postoperative complications.\u003c/p\u003e \u003cp\u003eFABP4 is a protein widely expressed in adipocytes and macrophages, first discovered in adipose tissue and mature fat cells in the 1980s. As a key regulator of lipid metabolism, FABP4 plays a crucial role in the body's metabolic processes. Its main functions include regulating lipid metabolism and inflammatory responses, which significantly influence the transport and utilization of fatty acids in the body. Studies have shown that elevated levels of FABP4 may be associated with an increased risk of metabolic diseases such as insulin resistance, type 2 diabetes, and atherosclerosis. Experimental evidence indicates that the FABP4 molecule directly impacts various cell types, including hepatocytes, macrophages, cardiomyocytes, vascular endothelial cells, and vascular smooth muscle cells. Despite some advances in research, the specific mechanisms of action of FABP4 and its potential receptors remain areas for further exploration. Therefore, FABP4 may play a crucial regulatory role in disease development, either by indirectly exacerbating traditional risk factors or by directly interfering with the metabolic processes in patients, leading to potential increased risks. Further studies on the mechanisms of action of FABP4 and its specific roles in metabolic diseases will contribute to a deeper understanding of its potential pathophysiological functions.\u003c/p\u003e \u003cp\u003eIn this study, the researchers discovered that the levels of FABP4 concentration within the body, ASA classification, and intraoperative EIBL were linked to the occurrence of early postoperative complications in patients undergoing TKA and THA. Despite the data originating solely from patients at a single medical facility, the varied sources of patients and the adequate sample size ensured the representation and applicability of the study outcomes. By utilizing multivariate logistic analysis, the researchers isolated FABP4 concentration, ASA classification, and EIBL as autonomous prognostic elements. When compared to the approach of single-variable analysis for selecting forecasting elements, the multivariate analysis not only outperforms but also integrates these elements to more precisely forecast the likelihood of postoperative complications. These results align with prior investigations and deepen our comprehension of how these prognostic factors contribute to postoperative complications[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on our knowledge, we are the first to investigate the correlation between intra-body concentration levels of FABP4 and postoperative complications following TKA or THA surgeries. However, we must acknowledge that the study has certain limitations. Firstly, since we only included Chinese patients, the generalizability to other ethnic groups remains to be validated. Secondly, despite adhering to predefined inclusion and exclusion criteria, the retrospective nature of the study may introduce some degree of selection bias. Lastly, the TKA/THA surgeries in our study were performed by multiple different surgeons, potentially leading to variations in surgical techniques. To enhance the reliability of our findings, we are actively expanding our recruitment scope to cover diverse geographical regions and clinical settings, and considering incorporating additional variables for future analyses.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHigher FABP4 concentration is very common in patients with adverse events occurring locally within the 90 days of TKA/THA and the prevalence of adverse events occurring locally within the 90 days of TKA/THA was higher in patients combined with higher FABP4 concentration, higher ASA class or EIBL. FABP4 concentration, ASA class and EIBL are risk factors for the development of adverse events occurring locally within the 90 days of TKA/THA, but validation in larger sample studies is still needed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAUC \u0026nbsp; area under the curve\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAST \u0026nbsp; aspartate transaminase,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eALT \u0026nbsp; alanine transaminase,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp;confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEIBL \u0026nbsp; estimated intraoperative blood loss\u003c/p\u003e\n\u003cp\u003eeGFR \u0026nbsp; estimated glomerular filtration rate,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFABP \u0026nbsp; Fatty Acid Binding Protein\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHDL \u0026nbsp; high-density lipoprotein,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLDL \u0026nbsp; low-density lipoprotein,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMAP \u0026nbsp; mean arterial pressure,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR \u0026nbsp; odds ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOA \u0026nbsp; Osteoarthritis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eROC \u0026nbsp; receiver operating characteristic\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTHA \u0026nbsp; total hip arthroplasty\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTKA \u0026nbsp; total knee arthroplasty\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are particularly grateful to all the people who have given us help on our\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eArticle.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design of the research:\u0026nbsp;Silong Lin,\u0026nbsp;Xianqi Zhang; Acquisition of data:\u0026nbsp;Xishang Xia; Analysis and interpretation of the data:\u0026nbsp;Xishang Xia\u003csup\u003e1\u003c/sup\u003e, Guishui Xu; Statistical analysis: Xianqi Zhang, Hong Pan; Obtaining financing:\u0026nbsp;Hong Pan; Writing of the manuscript:\u0026nbsp;Silong Lin; Critical revision of the manuscript for intellectual content:\u0026nbsp;Xianqi Zhang, Xishang Xia, Guishui Xu, Hong Pan; All authors read and approved the final draft\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by university-level scientific research program of South Anhui Medical College (JXYY202278) and Anhui Medical University Research Fund (2022XKJ094).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurther enquiries can be directed to the corresponding author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest regarding this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by Ethics Committee of Anqing First People\u0026rsquo;s Hospital of Anhui Medical University, and all participants have provided signed informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Orthopedic surgery, Anqing First People\u0026rsquo;s Hospital of Anhui Medical University, Anqing 246003, Anhui province, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eC\u0026eacute;sar Fern\u0026aacute;ndez-de-Las-Pe\u0026ntilde;as, Lidiane L Florencio , Ana I de-la-Llave-Rinc\u0026oacute;n, Ricardo Ortega-Santiago , Margarita Cigar\u0026aacute;n-M\u0026eacute;ndez, Stella Fuensalida-Novo, Gustavo Plaza-Manzano , Lars Arendt-Nielsen , Juan A Valera-Calero, Marcos J Navarro-Santana . Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review. J Clin Med. 2023 Oct 19;12(20):6624.\u003c/li\u003e\n\u003cli\u003eSamuel Joshua Pragasam Sampath, Vijayalakshmi Venkatesan, Sudip Ghosh, Nagasuryaprasad Kotikalapudi. Obesity, Metabolic Syndrome, and Osteoarthritis-An Updated Review. Curr Obes Rep. 2023 Sep;12(3):308-331.\u003c/li\u003e\n\u003cli\u003eLROI. Online LROI-report 2018 2018 [Available from: https://www.lroi-report.nl/previous-reports/online-lroi-report-2018/.\u003c/li\u003e\n\u003cli\u003eOECD. Health at a Glance 2017: OECD Indicators, OECD Publishing; 2017 [Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en;jsessionid=sHVPNloegsvfCp0tRJdc6BR7.ip-10-240-5-110\u003c/li\u003e\n\u003cli\u003eYue Shi , Chi-Chiu Wang , Liqun Wu , Yunqing Zhang , Aimin Xu, Yao Wang . Pathophysiological Insight into Fatty Acid-Binding Protein-4: Multifaced Roles in Reproduction, Pregnancy, and Offspring Health. Int J Mol Sci. 2023 Aug 10;24(16):12655\u003c/li\u003e\n\u003cli\u003eRahul Mallick , Sanjay Basak , Ranjit K Das , Antara Banerjee , Sujay Paul , Surajit Pathak , Asim K Duttaroy . Fatty Acids and their Proteins in Adipose Tissue Inflammation. Cell Biochem Biophys. 2024 Mar;82(1):35-51.\u003c/li\u003e\n\u003cli\u003eEllen M van der Ark-Vonk , Mike V Puijk , Gerard Pasterkamp , Sander W van der Laan . The Effects of FABP4 on Cardiovascular Disease in the Aging Population. Curr Atheroscler Rep. 2024 May;26(5):163-175.\u003c/li\u003e\n\u003cli\u003eKacey J Prentice , Alexandra Lee , Paulina Cedillo , Karen E Inouye , Meric Erikci Ertunc , Jillian K Riveros , Grace Yankun Lee , G\u0026ouml;khan S Hotamisligil . Sympathetic tone dictates the impact of lipolysis on FABP4 secretion. J Lipid Res. 2023 Jun;64(6):100386. doi: 10.1016/j.jlr.2023.100386.\u003c/li\u003e\n\u003cli\u003ePiyas Gargari, Pradip Mukhopadhyay, Banshi Saboo, Anoop Misra, Sujoy Ghosh . Fabkin and glucose homeostasis. Am. J. Cardiol. 106(8), 1118\u0026ndash;1123 (2010).\u003c/li\u003e\n\u003cli\u003eAntwi-Boasiako Oteng , Sander Kersten . Mechanisms of Action of trans Fatty Acids. Diabetes Metab Syndr. 2022 Aug;16(8):102565.\u003c/li\u003e\n\u003cli\u003eMatthew B Shirley , Michael B Stuart , Matthew R Claxton , Paul L Sousa et al , Contemporary Outcomes of Transfemoral Amputation After Total Knee Arthroplasty. J Arthroplasty. 2022 Jul;37(7):1359-1363.\u003c/li\u003e\n\u003cli\u003eChristopher Fenelon, Evelyn P Murphy , Eoin J Fahey , Robert P Murphy , Niamh M O\u0026apos;Connell , Joseph M Queally et al . Total Knee Arthroplasty in Hemophilia: Survivorship and Outcomes-A Systematic Review and Meta-Analysis. J Arthroplasty. 2022 Mar;37(3):581-592.e1.\u003c/li\u003e\n\u003cli\u003eErica J Weinstein, Alisa J Stephens-Shields , Craig W Newcomb , Randi Silibovsky , Charles L Nelson et al. Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty. JAMA Netw Open. 2023 Oct 2;6(10):e2340457\u003c/li\u003e\n\u003cli\u003eKosuke Inoue, Daniel M Blumenthal, David Elashoff, Yusuke Tsugawa et al. Association between physician characteristics and payments from industry in 2015-2017: observational study. BMJ Open. 2019 Sep 20;9(9):e031010\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"90-day local complications, TKA, THA, FABP4 concentration, ASA class, Osteoarthritis","lastPublishedDoi":"10.21203/rs.3.rs-4699232/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4699232/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to investigate the potential significance of FABP4 in predicting prognosis following total hip arthroplasty (THA) or total knee arthroplasty (TKA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study selected patients undergoing THA/TKA aged \u0026gt;18 years who were hospitalized in Anqing First People’s Hospital of Anhui Medical University. A total of 400 patients and 100 healthy subjects were finally included. Based on the results of 90-day follow-up data were included in the complication group, otherwise, they were classified as the no complications group. The demographic and clinical data of the two groups were compared, and the clinical characteristics and risk factors of local complications within 90 days of TKA/THA were evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFABP4 concentration (odds ratio (OR)=1.521 95% confidence interval (CI)=1.190–1.944, P =0.001), ASA class (OR=0.064 95% CI=0.005–0.811, P =0.034) and estimated intraoperative blood loss (OR=1.070, 95% CI=1.008–1.135, P=0.027) were found to be predictors of 90-Day Local Complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigher FABP4 concentration is very common in patients with adverse events occurring locally within the 90 days of TKA/THA and the prevalence of adverse events occurring locally within the 90 days of TKA/THA was higher in patients combined with higher FABP4 concentration, higher ASA class or EIBL. FABP4 concentration, ASA class and EIBL are risk factors for the development of adverse events occurring locally within the 90 days of TKA/THA, but validation in larger sample studies is still needed.\u003c/p\u003e","manuscriptTitle":"Correlation between the upregulation of circulating FABP4 and prognosis of joint replacement in patients with osteoarthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 21:24:46","doi":"10.21203/rs.3.rs-4699232/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2c650d8-d3ef-4c64-aed6-ad2173f3e5e9","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T02:44:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-09 21:24:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4699232","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4699232","identity":"rs-4699232","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}