The Predictive Value of Preoperative Fasting Blood Glucose Variability for Postoperative Infection in Orthopedic Patients

The Predictive Value of Preoperative Fasting Blood Glucose Variability for Postoperative Infection in Orthopedic Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Predictive Value of Preoperative Fasting Blood Glucose Variability for Postoperative Infection in Orthopedic Patients Hongping Xiong, Dingfang Fan, Jing Xu, Qing Zhou, Fengfei Lin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3985365/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To explore the predictive value of preoperative fasting blood glucose variability for postoperative infections in orthopedic patients. Methods A retrospective study was conducted to collect the medical records of 310 patients with type 2 diabetes who were hospitalized in the orthopaedics department of Fuzhou Second General Hospital from January 2022 to November 2023 by using the hospital electronic medical record system. According to whether there was postoperative infection, they were divided into two groups: no postoperative infection group ( n = 227) and postoperative infection group ( n = 83). The researchers designed a basic information scale to collect general patient information and fasting blood glucose (FPG) indicators from admission to surgery. Based on at least three fasting blood glucose values, FPG variability indicators were calculated, including standard deviation of fasting blood glucose (FPG-SD), coefficient of variation of fasting blood glucose(FPG-CV), and mean true variation of fasting blood glucose (FPG-ARV). Using univariate and multivariate logistic binary regression analysis to determine the independent risk factors for postoperative infection, analyzing the correlation between FPG-SD, FPG-CV, FPG-ARV and postoperative infection through point binary correlation studies, drawing receiver operating characteristic ( ROC ) curves, and calculating the area under the curve ( AUC ) to evaluate FPG-SD, FPG-CV The value of FPG-ARV alone and in combination in predicting postoperative infections in orthopedic patients. Results FPG-SD, FPG-CV, and FPG-ARV were all independent risk factors for postoperative infection in orthopedic patients ( P 0, P < 0.05); Draw ROC curves, and the orthopedics postoperative infection fasting blood glucose variability forecast Figures Figure 1 Background Surgical treatment is the most commonly used treatment in orthopedics, but orthopedic surgery has a high risk of trauma and blood loss, and because most operations require the implantation of metal stents, screws, artificial joints and other implants, patients have a high risk of postoperative infection, which is a common complication in orthopedic patients [ 1 ], and orthopedic postoperative infection accounts for 40% of hospital infection [ 2 ], resulting in prolonged hospital stay, increased additional medical costs Prolonging the rehabilitation process of patients may even lead to the failure of surgery [ 3 ]. Previous studies have shown that high preoperative fasting blood glucose is an independent risk factor for postoperative infection in fracture [ 4 ], and high or low blood glucose will increase the risk of postoperative infection. Compared with simple blood glucose level, blood glucose variability can more accurately reflect the fluctuation of blood glucose. The greater the blood glucose variability, the higher the risk of surgical complications and death [ 5 ]. Based on this, this study aimed to explore the predictive value of preoperative fasting blood glucose variability for postoperative infection in orthopedic patients. Object and Methods Research Object A total of 310 patients with type 2 diabetes who underwent surgical treatment in the Department of orthopedics of Fuzhou second general hospital from January 2022 to November 2023 were collected by using the hospital electronic medical record system. According to whether they had postoperative infection, they were divided into no postoperative infection group ( n = 227) and postoperative infection group ( n = 83). Inclusion criteria: ① all patients met the Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 version) [ 6 ]; ② Meet the operation indication; ③ After admission, all patients were treated with intensive insulin therapy; ④ The patients and their families voluntarily participated and signed the informed consent form; ⑤ The medical records are complete. Exclusion criteria: ① patients with preoperative infection, tumor and connective tissue disease were excluded; ② Did not receive blood glucose monitoring after admission or the duration of blood glucose monitoring was < 72h; ③ Combined with other serious metabolic diseases; ④ Patients with severe liver and kidney dysfunction. Fasting blood glucose measurement The patients in the study group collected the blood of the median vein of the elbow in the fasting state in the morning. The venous blood was placed in the coagulation promoting biochemical tube, centrifuged at 3000r/minutes for 10minutes, and the upper serum was taken and placed in the EP tube for determination by hexokinase method. The reagent was purchased from Mindray company, and the instrument was purchased from Mindray company's automatic biochemical analyzer. The instrument model was BS2000M. Definition and calculation of preoperative FBG variability index FPG long-term variability indicators are calculated based on FPG values at least three times, including standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). The calculation formula is as follows [ 7 ]: Determination of Postoperative Infection Postoperative incision infection was screened according to the diagnostic criteria for nosocomial infection [ 8 ]. Incision infections occurring within 30 days after surgery without implants and within 1 year after surgery with implants (such as artificial joints) were included in the screening. Postoperative wound infection can be diagnosed if one of the following conditions is met: ① the superficial incision has red, swollen, hot, painful, or purulent secretions; ② Pus was drawn from the deep incision or punctured, except for drainage after infectious surgery; ③ There are purulent secretions or fever ≥ 38 ℃ in the incision that is naturally cracked or opened by the surgeon, and there is local pain or tenderness; ④ The deep incision abscess or other evidence of infection was found after reoperation exploration, histopathology or imaging examination; ⑤ On the basis of infection diagnosed by clinicians, accompanied by the basis of etiological diagnosis,secretion culture is positive. Statistical methods SPSS 26.0 was used for statistical analysis. Before data analysis, normality and homogeneity of variance were tested. Continuous variable data were described in the form of mean ± standard deviation ( \(\overline{\text{x}}\pm\) S), and count data were expressed in frequency and constituent ratio (%). Wilcoxon rank sum test was used for comparison between groups; Univariate logistic and binary logistic regression analysis were used to explore whether FPG-SD, FPG-CV and FPG-ARV were independent risk factors for postoperative infection in orthopedics department; The correlation between FPG-SD, FPG-CV, FPG-ARV and orthopedic postoperative infection was analyzed by point binary correlation. Receiver operating characteristic ( ROC ) curves were drawn, and the area under the curve ( AUC ) was calculated. The value of FPG-SD, FPG-CV, FPG-ARV alone and in combination to predict orthopedic postoperative infection was evaluated. P< 0.05 indicated that the difference was statistically significant. Results Comparison of clinical data between the two groups A total of 310 patients with type 2 diabetes undergoing orthopedic surgery were included in this study. There were no significant differences in gender, body mass index (BMI), duration of diabetes, smoking history, history of hypertension, history of stroke, chronic lung disease, dyslipidemia, implant implantation, anesthesia mode, and anesthesia grading between the two groups ( p > 0.05). There were no significant differences in age, FPG-SD, FPG-CV, FPG-ARV The preoperative hemoglobin (HB) level, operation duration, and the number of patients undergoing open surgery were higher than those in the group without postoperative infection ( p < 0.05). See Table 1 for details. Table 1 Comparison of clinical data between the two groups of patients with type 2 diabetes undergoing orthopedic surgery clinical data No postoperative infection ( n = 227) Postoperative infection ( n = 83) Z/t/x 2 P Age (years) 63.21 ± 0.894 66.53 ± 1.369 3.328 0.001 Male [cases (%)] 111(48.9) 41(49.4) 0.006 0.938 BMI(kg/m 2 ) 26.45 ± 1.08 27.35 ± 2.67 -0.046 0.963 Duration of diabetes 7.87 ± 0.60 9.33 ± 1.49 0.206 0.836 FPG-SD(mmol/L) 1.09 ± 0.12 2.18 ± 0.08 8.665 0.000 FPG-CV(%) 0.14 ± 0.01 0.22 ± 0.01 7.262 0.000 FPG-ARV(mmol/L) 1.30 ± 0.06 2.75 ± 0.17 8.854 0.000 Smoking [cases (%)] 40(17.6) 12(14.5) 0.436 0.509 Hypertension [cases (%)] 110(48.5) 42(50.6) 0.112 0.738 Stroke [cases (%)] 13(5.7) 8(9.6) 1.473 0.225 Chronic lung disease [cases (%)] 79(34.8) 38(45.8) 0.944 0.331 Dyslipidemia 90(39.6) 38(45.8) 0.944 0.331 Preoperative HB 129.45 ± 2.89 131.44 ± 1.73 2.632 0.008 Operation duration 1.59 ± 0.16 2.08 ± 0.13 3.590 0.000 Open surgery [cases (%)] 5(2.2) 7(8.4) 6.342 0.019 Implants [cases (%)] 175(77.1) 72(86.7) 3.499 0.061 Anesthesia mode 2.258 0.323 general anesthesia 92(40.5) 34(41.0) local anesthesia 23(10.1) 4(4.8) Mixed anesthesia 112(49.3) 45(54.2) Anesthetic grading 1.247 0.742 P1 11(4.8) 5(6.0) P2 193(85.0) 67(80.7) P3 23(10.1) 11(13.3) Analysis of risk factors of preoperative fasting blood glucose variability on orthopedic postoperative infection Taking the occurrence of orthopedic postoperative infection as the dependent variable, the factors that may affect the occurrence of postoperative infection were age (years), sex, BMI, diabetes duration, smoking history, hypertension, stroke, chronic lung disease, dyslipidemia, preoperative HB, operation duration, operation method, implant, anesthesia method, and anesthesia grade. The results showed that age, preoperative Hb level, open surgery FPG-SD, FPG-CV and FPG-ARV are risk factors for postoperative infection in orthopedics department. The three indicators of FPG variability were analyzed as continuous variables, and were included in the binary logistic regression analysis model with the factors that may affect the occurrence of postoperative infection, such as age (years), preoperative HB, and open surgery. The results showed that FPG-SD, FPG-CV, and FPG-ARV were all independent risk factors for the occurrence of postoperative infection in orthopedics after adjusting for other variables ( p < 0.05). See Table 2 for details. Table 2 Effect of preoperative fasting blood glucose variability on orthopedic postoperative infection Model β SE Wald P OR 95% CI Lower Limit High limit Model 1(FPG-SD) 1.347 0.194 2.918 0.000 3.847 0.996 1.056 Model 2(FPG-CV) 0.085 0.015 30.284 0.000 1.089 1.056 1.112 Model 3(FPG-ARV) 1.100 0.154 51.057 0.000 3.003 2.221 4.060 Note: Model 1:FPG-SD, age, preoperative HB level, open surgery; Model 2:FPG-CV, age, preoperative HB level, open surgery; Model 3:FPG-ARV, age, preoperative HB level, open surgery. Correlation between preoperative fasting blood glucose variability and postoperative infection in orthopedics The correlation between FPG-SD, FPG-CV, FPG-ARV levels and orthopedic postoperative infection was explored by using point of use binary correlation analysis. It was found that FPG-SD, FPG-CV, FPG-ARV levels were positively correlated with the occurrence of orthopedic postoperative infection ( p < 0.05), see Table 3 . Table 3 Correlation Analysis between preoperative fasting blood glucose variability and postoperative infection Group r p FPG-SD 0.504 0.000 FPG-CV 0.378 0.000 FPG-ARV 0.504 0.000 The value of fasting blood glucose variability in predicting postoperative infection in orthopedics The ROC curve was drawn ( Fig. 1 ). The results showed that the area under the curve of FPG-SD, FPG-CV and FPG-ARV levels to predict postoperative infection after orthopedic surgery was AUC > 0.7. See Table 4 for details. It has a certain predictive value, and the value of joint prediction is higher. Table 4 Value analysis of preoperative fasting blood glucose variability in predicting postoperative infection Parameter AUC 95% CI Lower Limit High limit P Cut off value Specificity Sensitivity Youden index FPG-SD 0.821 0.768 0.875 0.000 1.358 0.713 0.819 0.550 FPG-CV 0.769 0.711 0.827 0.000 0.160 0.700 0.759 0.700 FPG-ARV 0.824 0.770 0.879 0.000 1.725 0.784 0.771 0.555 Joint Ediction 0.844 0.792 0.896 0.000 0.855 0.723 0.578 Discussions Persistent hyperglycemia is an independent risk factor for nosocomial infection [ 9 , 10 ]. Hyperglycemia will acutely increase the concentration of inflammatory cytokines through oxidative stress [ 11 ], can activate protein kinase C (PKC), and then inhibit the migration, phagocytosis, peroxidase production and bactericidal effect of neutrophils. High glucose concentration will inhibit the formation of neutrophil extracellular bactericidal network, and can also induce the expression of Toll like receptors, Inhibit neutrophil function and apoptosis. In addition, in the initial inflammatory response, high glucose concentration will reduce vasodilation and increase permeability, possibly through protein kinase C activation. Hyperglycemia will lead to direct glycosylation of proteins and change the tertiary structure of complement; These changes inhibited immunoglobulin mediated immobilization of photosynthetic bacteria and reduced phagocytosis [ 12 ]. In patients with long-term hyperglycemia, the blood viscosity in the body increases, which causes the blood circulation in the body to slow down, thus significantly increasing the incidence of venous thrombosis, resulting in blood stasis around the prosthesis, and the prosthesis infection rate increases significantly [ 13 ]. And the continuous rise of blood glucose can damage the body's immune system and increase the chance of pathogen colonization; At the same time, it can provide a favorable environment for the growth of pathogenic bacteria, resulting in an increased risk of postoperative infection [ 14 ]. Therefore, monitoring the variability of fasting blood glucose before operation is of great value to prevent postoperative infection. FPG-SD, FPG-CV, FPG-ARV are the main indicators to reflect the variability of fasting blood glucose. At present, the variability of FPG has not been clarified in the study of orthopedic postoperative infection. In this study, patients with postoperative infection had high expression of preoperative FPG-SD, FPG-CV, and FPG-ARV levels. After adjusting for confounding factors, it was found that FPG-SD, FPG-CV, and FPG-ARV were independent risk factors for orthopedic postoperative infection. In this study, the higher the levels of FPG-SD, FPG-CV, and FPG-ARV, The higher the risk of postoperative infection, the indicators have a certain predictive value for the occurrence of postoperative infection, and the joint predictive value is higher. At present, the pathophysiological mechanism of FPG variability leading to postoperative infection is not clear, but it is related to the following aspects. First, animal studies have shown that FPG variability tends to exacerbate oxidative stress and has a negative effect on β Cell function causes chronic damage, including overexpression of oxidative biomarkers, overproduction of free radical oxygen species and cell apoptosis, rapid fasting blood glucose fluctuations induce nitrosative stress, enhance the formation and activation of free radicals of poly polymerase pathway, thus damaging endothelial function [ 15 ], leading to vascular endothelial dysfunction, making a large number of IL-6, TNF- α And other inflammatory factors are released. Second, it has been reported that the larger fasting blood glucose fluctuation has a more specific triggering effect on oxidative stress response than chronic persistent hyperglycemia [ 16 ], and then triggers the inflammatory response. However, there are the following limitations in this study: 1. the time from the initial monitoring of FPG to surgery varies among the enrolled patients, resulting in differences in the number of FBG monitoring, up to 16 times at most and only 3 times at least. 2. this study is a single center retrospective study with a small sample size, so it is difficult to avoid selection bias in the selection of research subjects. 3. although the intensive insulin treatment plan was adjusted in this study, the baseline calibration of pre admission glucose lowering plan and fasting blood glucose level was not carried out, and the potential impact of pre admission fasting blood glucose level cannot be ruled out. Conclusions In conclusion, preoperative FPG-SD, FPG-CV, and FPG-ARV are independent risk factors for postoperative infection, and are positively correlated with postoperative infection. Preoperative fasting blood glucose variability can predict the occurrence of orthopedic postoperative infection, and the combined application of FPG-SD, FPG-CV, FPG-ARV levels has higher predictive value. Clinically, we can monitor the fasting blood glucose level of patients, calculate the variability of fasting blood glucose level of patients, so as to comprehensively consider and decide the treatment plan, which is of positive significance to reduce the risk of postoperative infection. Abbreviations FPG-SD standard deviation of fasting blood glucose FPG-CV coefficient of variation of fasting blood glucose FPG-ARV mean true variatio of fasting blood glucose ROC receiver operating characteristic AUC area under the curve PKC protein kinase C Declarations Acknowledgements Not applicable. Authors ’ contributions Fengfei,Lin conceived and supervised the study. Hongping Xiong and Dingfang Fan carried out the search process and data collection. Jing Xu and Qiang Zhou assessed the quality of the study. Hongping Xiong and Dingfang Fan drafted the manuscript. All the authors have read and approved the final manuscript. Authors ’ information Not applicable. Funding This study was funded by Fuzhou Clinical Key Specialty Construction Project and 2023 Fujian Provincial Clinical Key Specialty Construction Project (Minwei Medical Policy Letter [2023] No. 1163). Availability of data and materials The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate All experimental plans have been approved by the Ethics Committee of the Fuzhou Second General Hospital, Fuzhou, Fujian, People's Republic of China, and it has been confirmed that informed consent has been obtained from all subjects and/or their legal guardians. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1 Department of Endocrinology, Fuzhou Second Hospital, Fuzhou, Fujian, People's Republic of China； 2 Trauma Orthopedics,Fuzhou Second Hospital, Fuzhou, Fujian, People's Republic of China； 3 Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China. References Kümin M, Harper CM, Reed M, Scarborough M, et al. Reducing Implant Infection in Orthopaedics (RIIiO): a pilot study for a randomised controlled trial comparing the influence of forced air versus resistive fabric warming technologies on postoperative infection rates following orthopaedic implant surgery in adults. Trials[J]. 2018;19(1):640. Jain RK, Shukla R, Singh P, et al. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery[J]. Eur J Orthop Surg Traumatol. 2015;25(2):251–4. Law TY, Moeller E, Hubbard ZS, et al. Preoperative Hypoglycemia and Hyperglycemia Are Related to Postoperative Infection Rates in Implant-Based Breast Reconstruction. J Surg Res[J]. 2018;232:437–41. Ma T, Lu K, Song L, Wang D, et al. Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery[J]. J Invest Surg. 2020;33(8):750–8. 《The working group of. guidelines for multidisciplinary management of perioperative common problems in elderly patients with spinal surgery, the cervical spondylology group of the orthopedic branch of the Chinese Medical Association, the spine medicine branch of the China Association for the promotion of international exchanges in health care, guidelines for multidisciplinary management of perioperative common problems in elderly patients with spinal surgery [J]. Chinese Journal of bone and joint surgery.2023,16 (11): 961–980. Diabetes Branch of Chinese Medical Association. Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 Edition) [J]. Int J Endocrinol metabolism.2021,41 (05): 482–548. Deravi N, Sharifi Y, Koohi F, et al. The association between fasting plasma glucose variability and incident eGFR decline: evidence from two cohort studies. BMC Public Health. 2023;23(1):565. Ministry of health of the People's Republic of China. Diagnostic criteria for nosocomial infections (Trial) [J]. Chinese medical journal.2001,81 (5): 314–20. Jia Fu. Influencing factors of nosocomial infection in acute ischemic stroke and its impact on long-term prognosis [J]. J Clin Neurol. 2019;32(04):285–8. Wang YLTSX et al. Analysis of prognostic factors of pulmonary infection in patients with acute stroke [J]. Chin J Nosocom infectology.2016,26 (14): 3213–5. Esposito K, Nappo F, Marfella R, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation. 2002;106(16):2067–72. Jafar N. Edriss H,Nugent K.The effect of short-term hyperglycemia on the innate immune system[J]. Am J Med Sci. 2016;351(2):201–11. Tkach DC, Young AJ, Smith LH et al. Real-time and offline performance of pattern recognition myoelectric control using a generic electrode grid with targeted muscle reinnervation patients[J]. IEEE Trans Neural Syst Rehabil Eng 2014,22(4):727–34. Pollmann CT, Dahl FA,Røtterud JHM, et al. Surgical site infection after hip fracture-mortality and risk factors:An observational cohort study of 1709 patients[J]. Acta Orthop. 2020;91(3):347–52. Horváth EM, Benko R, Kiss L, et al. Rapid 'glycaemic swings' induce nitrosative stress, activate poly(ADP-ribose) polymerase and impair endothelial function in a rat model of diabetes mellitus. Diabetologia[J]. 2009;52(5):952–61. 10.1007/s00125-009-1304-0 . Epub 2009 Mar 5. Monnier L, Mas E, Ginet C, Michel F, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes[J]. JAMA. 2006;295(14):1681–7. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3985365","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276756322,"identity":"85b5602c-fc83-488f-9144-16308e84d3cc","order_by":0,"name":"Hongping Xiong","email":"","orcid":"","institution":"Department of Endocrinology, Fuzhou Second General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hongping","middleName":"","lastName":"Xiong","suffix":""},{"id":276756323,"identity":"cda7219e-5191-423b-a1f3-05f2ac46d605","order_by":1,"name":"Dingfang Fan","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Dingfang","middleName":"","lastName":"Fan","suffix":""},{"id":276756324,"identity":"b25918a6-88aa-43b5-a102-006b04056f07","order_by":2,"name":"Jing Xu","email":"","orcid":"","institution":"Department of Endocrinology, Fuzhou Second General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Xu","suffix":""},{"id":276756325,"identity":"f773a4e1-012f-498d-9516-a22b1201a96c","order_by":3,"name":"Qing Zhou","email":"","orcid":"","institution":"Department of Endocrinology, Fuzhou Second General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Zhou","suffix":""},{"id":276756326,"identity":"9403b444-cb98-48cb-8090-c13410de10fe","order_by":4,"name":"Fengfei Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBAC+/bm459/VNgwM7Y3EKnFgOdYGjPDmTR25p4DxGqRyFFjZmw7xM8+I4FILeYSOWyPC84ckOad+XjjDYYam2iCWix73h43nlFxx1hydlqxBcOxtNwGgnqO5yVI8Jx5lmw4O8dMgrHhMBFaDuQYSPC2Ha7ff/MMkVoMTuSYSQO1MDPO4CFSi2TPsWTDGWfSmBl7gH5JIMYv/OzNBx98AEfl4Y03PtTYEOEXZEdKJJCiHKKFVB2jYBSMglEwMgAANctFa8z/xPQAAAAASUVORK5CYII=","orcid":"","institution":"Trauma Orthopedics,Fuzhou Second General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Fengfei","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2024-02-24 15:22:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3985365/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3985365/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52298256,"identity":"b4287618-a2ab-4116-859a-6c85b6f8272d","added_by":"auto","created_at":"2024-03-08 18:13:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39857,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves of FPG-SD, FPG-CV, FPG-ARV and joint prediction\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-3985365/v1/e8c148487eb621f896e8e1d7.png"},{"id":88964967,"identity":"0316d0ad-fa18-4d88-9080-b7b24c80b7c8","added_by":"auto","created_at":"2025-08-13 08:48:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":924234,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3985365/v1/66921c23-ef03-4901-b260-f0153f6fdb19.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Predictive Value of Preoperative Fasting Blood Glucose Variability for Postoperative Infection in Orthopedic Patients","fulltext":[{"header":"Background","content":"\u003cp\u003eSurgical treatment is the most commonly used treatment in orthopedics, but orthopedic surgery has a high risk of trauma and blood loss, and because most operations require the implantation of metal stents, screws, artificial joints and other implants, patients have a high risk of postoperative infection, which is a common complication in orthopedic patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and orthopedic postoperative infection accounts for 40% of hospital infection [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], resulting in prolonged hospital stay, increased additional medical costs Prolonging the rehabilitation process of patients may even lead to the failure of surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Previous studies have shown that high preoperative fasting blood glucose is an independent risk factor for postoperative infection in fracture [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and high or low blood glucose will increase the risk of postoperative infection. Compared with simple blood glucose level, blood glucose variability can more accurately reflect the fluctuation of blood glucose. The greater the blood glucose variability, the higher the risk of surgical complications and death [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Based on this, this study aimed to explore the predictive value of preoperative fasting blood glucose variability for postoperative infection in orthopedic patients.\u003c/p\u003e "},{"header":"Object and Methods","content":"\u003cp\u003e \u003cb\u003eResearch Object\u003c/b\u003e \u003c/p\u003e\u003cp\u003eA total of 310 patients with type 2 diabetes who underwent surgical treatment in the Department of orthopedics of Fuzhou second general hospital from January 2022 to November 2023 were collected by using the hospital electronic medical record system. According to whether they had postoperative infection, they were divided into no postoperative infection group (\u003cem\u003en\u003c/em\u003e = 227) and postoperative infection group (\u003cem\u003en\u003c/em\u003e = 83). Inclusion criteria: ① all patients met the Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 version) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]; ② Meet the operation indication; ③ After admission, all patients were treated with intensive insulin therapy; ④ The patients and their families voluntarily participated and signed the informed consent form; ⑤ The medical records are complete. Exclusion criteria: ① patients with preoperative infection, tumor and connective tissue disease were excluded; ② Did not receive blood glucose monitoring after admission or the duration of blood glucose monitoring was \u0026lt; 72h; ③ Combined with other serious metabolic diseases; ④ Patients with severe liver and kidney dysfunction.\u003c/p\u003e\u003cp\u003e \u003cb\u003eFasting blood glucose measurement\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe patients in the study group collected the blood of the median vein of the elbow in the fasting state in the morning. The venous blood was placed in the coagulation promoting biochemical tube, centrifuged at 3000r/minutes for 10minutes, and the upper serum was taken and placed in the EP tube for determination by hexokinase method. The reagent was purchased from Mindray company, and the instrument was purchased from Mindray company's automatic biochemical analyzer. The instrument model was BS2000M.\u003c/p\u003e\u003cp\u003e \u003cb\u003eDefinition and calculation of preoperative FBG variability index\u003c/b\u003e \u003c/p\u003e\u003cp\u003eFPG long-term variability indicators are calculated based on FPG values at least three times, including standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). The calculation formula is as follows [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]:\u003c/p\u003e\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e \u003cb\u003eDetermination of Postoperative Infection\u003c/b\u003e \u003c/p\u003e\u003cp\u003ePostoperative incision infection was screened according to the diagnostic criteria for nosocomial infection [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Incision infections occurring within 30 days after surgery without implants and within 1 year after surgery with implants (such as artificial joints) were included in the screening. Postoperative wound infection can be diagnosed if one of the following conditions is met: ① the superficial incision has red, swollen, hot, painful, or purulent secretions; ② Pus was drawn from the deep incision or punctured, except for drainage after infectious surgery; ③ There are purulent secretions or fever ≥ 38 ℃ in the incision that is naturally cracked or opened by the surgeon, and there is local pain or tenderness; ④ The deep incision abscess or other evidence of infection was found after reoperation exploration, histopathology or imaging examination; ⑤ On the basis of infection diagnosed by clinicians, accompanied by the basis of etiological diagnosis,secretion culture is positive.\u003c/p\u003e\u003cp\u003e \u003cb\u003eStatistical methods\u003c/b\u003e \u003c/p\u003e\u003cp\u003eSPSS 26.0 was used for statistical analysis. Before data analysis, normality and homogeneity of variance were tested. Continuous variable data were described in the form of mean ± standard deviation (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\overline{\\text{x}}\\pm\\)\u003c/span\u003e\u003c/span\u003eS), and count data were expressed in frequency and constituent ratio (%). Wilcoxon rank sum test was used for comparison between groups; Univariate logistic and binary logistic regression analysis were used to explore whether FPG-SD, FPG-CV and FPG-ARV were independent risk factors for postoperative infection in orthopedics department; The correlation between FPG-SD, FPG-CV, FPG-ARV and orthopedic postoperative infection was analyzed by point binary correlation. Receiver operating characteristic (\u003cem\u003eROC\u003c/em\u003e) curves were drawn, and the area under the curve (\u003cem\u003eAUC\u003c/em\u003e) was calculated. The value of FPG-SD, FPG-CV, FPG-ARV alone and in combination to predict orthopedic postoperative infection was evaluated. \u003cem\u003eP\u0026lt;\u003c/em\u003e0.05 indicated that the difference was statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eComparison of clinical data between the two groups\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA total of 310 patients with type 2 diabetes undergoing orthopedic surgery were included in this study. There were no significant differences in gender, body mass index (BMI), duration of diabetes, smoking history, history of hypertension, history of stroke, chronic lung disease, dyslipidemia, implant implantation, anesthesia mode, and anesthesia grading between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There were no significant differences in age, FPG-SD, FPG-CV, FPG-ARV The preoperative hemoglobin (HB) level, operation duration, and the number of patients undergoing open surgery were higher than those in the group without postoperative infection (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical data between the two groups of patients with type 2 diabetes undergoing orthopedic surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eclinical data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo postoperative infection\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;227)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative infection\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ/t/x\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale [cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111(48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-SD(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-CV(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-ARV(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking [cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension [cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110(48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke [cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic lung disease\u003c/p\u003e \u003cp\u003e[cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79(34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90(39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative HB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen surgery [cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplants [cases (%)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175(77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egeneral anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92(40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elocal anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112(49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthetic grading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193(85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67(80.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis of risk factors of preoperative fasting blood glucose variability on orthopedic postoperative infection\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTaking the occurrence of orthopedic postoperative infection as the dependent variable, the factors that may affect the occurrence of postoperative infection were age (years), sex, BMI, diabetes duration, smoking history, hypertension, stroke, chronic lung disease, dyslipidemia, preoperative HB, operation duration, operation method, implant, anesthesia method, and anesthesia grade. The results showed that age, preoperative Hb level, open surgery FPG-SD, FPG-CV and FPG-ARV are risk factors for postoperative infection in orthopedics department. The three indicators of FPG variability were analyzed as continuous variables, and were included in the binary logistic regression analysis model with the factors that may affect the occurrence of postoperative infection, such as age (years), preoperative HB, and open surgery. The results showed that FPG-SD, FPG-CV, and FPG-ARV were all independent risk factors for the occurrence of postoperative infection in orthopedics after adjusting for other variables (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for details.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffect of preoperative fasting blood glucose variability on orthopedic postoperative infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% \u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003cp\u003eLower Limit High limit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 1(FPG-SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2(FPG-CV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 3(FPG-ARV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: Model 1:FPG-SD, age, preoperative HB level, open surgery; Model 2:FPG-CV, age, preoperative HB level, open surgery; Model 3:FPG-ARV, age, preoperative HB level, open surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eCorrelation between preoperative fasting blood glucose variability and postoperative infection in orthopedics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe correlation between FPG-SD, FPG-CV, FPG-ARV levels and orthopedic postoperative infection was explored by using point of use binary correlation analysis. It was found that FPG-SD, FPG-CV, FPG-ARV levels were positively correlated with the occurrence of orthopedic postoperative infection (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Analysis between preoperative fasting blood glucose variability and postoperative infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-CV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-ARV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe value of fasting blood glucose variability in predicting postoperative infection in orthopedics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe \u003cem\u003eROC\u003c/em\u003e curve was drawn ( Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The results showed that the area under the curve of FPG-SD, FPG-CV and FPG-ARV levels to predict postoperative infection after orthopedic surgery was \u003cem\u003eAUC\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.7. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for details. It has a certain predictive value, and the value of joint prediction is higher.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eValue analysis of preoperative fasting blood glucose variability in predicting postoperative infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAUC\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% \u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003cp\u003eLower Limit High limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCut off value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYouden index\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-CV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG-ARV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoint Ediction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003ePersistent hyperglycemia is an independent risk factor for nosocomial infection [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Hyperglycemia will acutely increase the concentration of inflammatory cytokines through oxidative stress [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], can activate protein kinase C (PKC), and then inhibit the migration, phagocytosis, peroxidase production and bactericidal effect of neutrophils. High glucose concentration will inhibit the formation of neutrophil extracellular bactericidal network, and can also induce the expression of Toll like receptors, Inhibit neutrophil function and apoptosis. In addition, in the initial inflammatory response, high glucose concentration will reduce vasodilation and increase permeability, possibly through protein kinase C activation. Hyperglycemia will lead to direct glycosylation of proteins and change the tertiary structure of complement; These changes inhibited immunoglobulin mediated immobilization of photosynthetic bacteria and reduced phagocytosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In patients with long-term hyperglycemia, the blood viscosity in the body increases, which causes the blood circulation in the body to slow down, thus significantly increasing the incidence of venous thrombosis, resulting in blood stasis around the prosthesis, and the prosthesis infection rate increases significantly [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. And the continuous rise of blood glucose can damage the body's immune system and increase the chance of pathogen colonization; At the same time, it can provide a favorable environment for the growth of pathogenic bacteria, resulting in an increased risk of postoperative infection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, monitoring the variability of fasting blood glucose before operation is of great value to prevent postoperative infection. FPG-SD, FPG-CV, FPG-ARV are the main indicators to reflect the variability of fasting blood glucose. At present, the variability of FPG has not been clarified in the study of orthopedic postoperative infection. In this study, patients with postoperative infection had high expression of preoperative FPG-SD, FPG-CV, and FPG-ARV levels. After adjusting for confounding factors, it was found that FPG-SD, FPG-CV, and FPG-ARV were independent risk factors for orthopedic postoperative infection. In this study, the higher the levels of FPG-SD, FPG-CV, and FPG-ARV, The higher the risk of postoperative infection, the indicators have a certain predictive value for the occurrence of postoperative infection, and the joint predictive value is higher.\u003c/p\u003e \u003cp\u003eAt present, the pathophysiological mechanism of FPG variability leading to postoperative infection is not clear, but it is related to the following aspects. First, animal studies have shown that FPG variability tends to exacerbate oxidative stress and has a negative effect on β Cell function causes chronic damage, including overexpression of oxidative biomarkers, overproduction of free radical oxygen species and cell apoptosis, rapid fasting blood glucose fluctuations induce nitrosative stress, enhance the formation and activation of free radicals of poly polymerase pathway, thus damaging endothelial function [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], leading to vascular endothelial dysfunction, making a large number of IL-6, TNF- α And other inflammatory factors are released. Second, it has been reported that the larger fasting blood glucose fluctuation has a more specific triggering effect on oxidative stress response than chronic persistent hyperglycemia [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and then triggers the inflammatory response. However, there are the following limitations in this study: 1. the time from the initial monitoring of FPG to surgery varies among the enrolled patients, resulting in differences in the number of FBG monitoring, up to 16 times at most and only 3 times at least. 2. this study is a single center retrospective study with a small sample size, so it is difficult to avoid selection bias in the selection of research subjects. 3. although the intensive insulin treatment plan was adjusted in this study, the baseline calibration of pre admission glucose lowering plan and fasting blood glucose level was not carried out, and the potential impact of pre admission fasting blood glucose level cannot be ruled out.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, preoperative FPG-SD, FPG-CV, and FPG-ARV are independent risk factors for postoperative infection, and are positively correlated with postoperative infection. Preoperative fasting blood glucose variability can predict the occurrence of orthopedic postoperative infection, and the combined application of FPG-SD, FPG-CV, FPG-ARV levels has higher predictive value. Clinically, we can monitor the fasting blood glucose level of patients, calculate the variability of fasting blood glucose level of patients, so as to comprehensively consider and decide the treatment plan, which is of positive significance to reduce the risk of postoperative infection.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFPG-SD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estandard deviation of fasting blood glucose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFPG-CV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecoefficient of variation of fasting blood glucose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFPG-ARV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emean true variatio of fasting blood glucose\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ereceiver operating characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003earea under the curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePKC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eprotein kinase C\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFengfei,Lin conceived and supervised the study. Hongping Xiong and Dingfang Fan carried out the search process and data collection. Jing Xu and Qiang Zhou assessed the quality of the study. Hongping Xiong and Dingfang Fan drafted the manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einformation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Fuzhou Clinical Key Specialty Construction Project and 2023 Fujian Provincial Clinical Key Specialty Construction Project (Minwei Medical Policy Letter [2023] No. 1163).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll experimental plans have been approved by the Ethics Committee of the Fuzhou Second General Hospital, Fuzhou, Fujian, People\u0026apos;s Republic of China, and it has been confirmed that informed consent has been obtained from all subjects and/or their legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eDepartment of Endocrinology, Fuzhou Second Hospital, Fuzhou, Fujian, People\u0026apos;s Republic of China；\u003csup\u003e2\u003c/sup\u003e Trauma Orthopedics,Fuzhou Second Hospital, Fuzhou, Fujian, People\u0026apos;s Republic of China；\u003csup\u003e3\u003c/sup\u003e Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People\u0026apos;s Republic of China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eK\u0026uuml;min M, Harper CM, Reed M, Scarborough M, et al. Reducing Implant Infection in Orthopaedics (RIIiO): a pilot study for a randomised controlled trial comparing the influence of forced air versus resistive fabric warming technologies on postoperative infection rates following orthopaedic implant surgery in adults. Trials[J]. 2018;19(1):640.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain RK, Shukla R, Singh P, et al. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery[J]. Eur J Orthop Surg Traumatol. 2015;25(2):251\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaw TY, Moeller E, Hubbard ZS, et al. Preoperative Hypoglycemia and Hyperglycemia Are Related to Postoperative Infection Rates in Implant-Based Breast Reconstruction. J Surg Res[J]. 2018;232:437\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa T, Lu K, Song L, Wang D, et al. Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery[J]. J Invest Surg. 2020;33(8):750\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e《The working group of. guidelines for multidisciplinary management of perioperative common problems in elderly patients with spinal surgery, the cervical spondylology group of the orthopedic branch of the Chinese Medical Association, the spine medicine branch of the China Association for the promotion of international exchanges in health care, guidelines for multidisciplinary management of perioperative common problems in elderly patients with spinal surgery [J]. Chinese Journal of bone and joint surgery.2023,16 (11): 961\u0026ndash;980.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiabetes Branch of Chinese Medical Association. Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 Edition) [J]. Int J Endocrinol metabolism.2021,41 (05): 482\u0026ndash;548.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeravi N, Sharifi Y, Koohi F, et al. The association between fasting plasma glucose variability and incident eGFR decline: evidence from two cohort studies. BMC Public Health. 2023;23(1):565.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of health of the People's Republic of China. Diagnostic criteria for nosocomial infections (Trial) [J]. Chinese medical journal.2001,81 (5): 314\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJia Fu. Influencing factors of nosocomial infection in acute ischemic stroke and its impact on long-term prognosis [J]. J Clin Neurol. 2019;32(04):285\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang YLTSX et al. Analysis of prognostic factors of pulmonary infection in patients with acute stroke [J]. Chin J Nosocom infectology.2016,26 (14): 3213\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsposito K, Nappo F, Marfella R, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation. 2002;106(16):2067\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafar N. Edriss H,Nugent K.The effect of short-term hyperglycemia on the innate immune system[J]. Am J Med Sci. 2016;351(2):201\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTkach DC, Young AJ, Smith LH et al. Real-time and offline performance of pattern recognition myoelectric control using a generic electrode grid with targeted muscle reinnervation patients[J]. IEEE Trans Neural Syst Rehabil Eng 2014,22(4):727\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePollmann CT, Dahl FA,R\u0026oslash;tterud JHM, et al. Surgical site infection after hip fracture-mortality and risk factors:An observational cohort study of 1709 patients[J]. Acta Orthop. 2020;91(3):347\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorv\u0026aacute;th EM, Benko R, Kiss L, et al. Rapid 'glycaemic swings' induce nitrosative stress, activate poly(ADP-ribose) polymerase and impair endothelial function in a rat model of diabetes mellitus. Diabetologia[J]. 2009;52(5):952\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00125-009-1304-0\u003c/span\u003e\u003cspan address=\"10.1007/s00125-009-1304-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2009 Mar 5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonnier L, Mas E, Ginet C, Michel F, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes[J]. JAMA. 2006;295(14):1681\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\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":"orthopedics, postoperative infection, fasting blood glucose variability, forecast","lastPublishedDoi":"10.21203/rs.3.rs-3985365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3985365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo explore the predictive value of preoperative fasting blood glucose variability for postoperative infections in orthopedic patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted to collect the medical records of 310 patients with type 2 diabetes who were hospitalized in the orthopaedics department of Fuzhou Second General Hospital from January 2022 to November 2023 by using the hospital electronic medical record system. According to whether there was postoperative infection, they were divided into two groups: no postoperative infection group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;227) and postoperative infection group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83). The researchers designed a basic information scale to collect general patient information and fasting blood glucose (FPG) indicators from admission to surgery. Based on at least three fasting blood glucose values, FPG variability indicators were calculated, including standard deviation of fasting blood glucose (FPG-SD), coefficient of variation of fasting blood glucose(FPG-CV), and mean true variation of fasting blood glucose (FPG-ARV). Using univariate and multivariate logistic binary regression analysis to determine the independent risk factors for postoperative infection, analyzing the correlation between FPG-SD, FPG-CV, FPG-ARV and postoperative infection through point binary correlation studies, drawing receiver operating characteristic (\u003cem\u003eROC\u003c/em\u003e) curves, and calculating the area under the curve (\u003cem\u003eAUC\u003c/em\u003e) to evaluate FPG-SD, FPG-CV The value of FPG-ARV alone and in combination in predicting postoperative infections in orthopedic patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFPG-SD, FPG-CV, and FPG-ARV were all independent risk factors for postoperative infection in orthopedic patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); According to point two column correlation analysis, FPG-SD, FPG-CV, FPG-ARV are positively correlated with the occurrence of postoperative infections in orthopedic patients (\u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); Draw ROC curves, and the\u003c/p\u003e","manuscriptTitle":"The Predictive Value of Preoperative Fasting Blood Glucose Variability for Postoperative Infection in Orthopedic Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-08 18:13:54","doi":"10.21203/rs.3.rs-3985365/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":"7fcaf42a-f91d-4b65-83ed-5d096d3f836b","owner":[],"postedDate":"March 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-13T08:40:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-08 18:13:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3985365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3985365","identity":"rs-3985365","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}