title: Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation. A prospective study on 177 patients.
abstract: OBJECTIVE
  The role of inflammation and fibrinolysis for the development of back pain and sciatica has been discussed. The aim of this study was to assess the relationship between markers of inflammation and fibrinolysis, to predict the outcome after surgery for lumbar disc herniation.
  
  
  METHODS
  177 patients were recruited. High sensitive C-reactive protein (hsCRP), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, and D-dimer were analyzed preoperatively. Visual analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5 Dimensions (EQ-5D) were assessed preoperatively and at 6 weeks, 6-, 12-, and 24- months postoperatively. Dichotomization was made at the median for the laboratory analyses, and between the worst quartile and the other three quartiles for the outcome variables. Logistic regression was used to determine the odds ratios (OR) and 95 % confidence intervals (CI).
  
  
  RESULTS
  The associations between PAI-1 and outcome seemed to be most prominent at the 6 and 12-month follow-up. When being in the upper half of PAI-1, the OR for being in the worst quartile of VAS back pain 12 months postoperatively was 3.33 (1.56-7.10). The corresponding OR for VAS leg pain was 2.46 (1.18-5.10), for ODI 2.83 (1.35-5.94) and for EQ-5D 2.73 (1.30-5.75). The OR for hsCRP was 2.10 (1.03-4.29) for being in the worst quartile of VAS back pain. Fibrinogen or D-dimer was not associated with any outcome variable.
  
  
  CONCLUSIONS
  High PAI-1, a marker of fibrinolysis, was fairly consistently associated with poor outcome, while hsCRP, fibrinogen, and D-dimer were not.
authors.affiliation: Department of Orthopedics, Södersjukhuset, SE-118 83, Stockholm, Sweden. peter.elkan@sodersjukhuset.se.|Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden. peter.elkan@sodersjukhuset.se.|CLINTEC, Karolinska Institutet, SE-141 86, Stockholm, Sweden. peter.elkan@sodersjukhuset.se.
authors.forename: P
authors.identifier: http://orcid.org/0000-0001-8299-4800
authors.initials: P
authors.lastname: Elkan
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Clinical Chemistry, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Sten-Linder
authors.affiliation: Department of Orthopedics, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Hedlund
authors.affiliation: Department of Orthopedics, Södersjukhuset, SE-118 83, Stockholm, Sweden.|Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Willers
authors.affiliation: Department of Orthopedics, Södersjukhuset, SE-118 83, Stockholm, Sweden.|Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Ponzer
authors.affiliation: CLINTEC, Karolinska Institutet, SE-141 86, Stockholm, Sweden.|Department of Orthopedics, K54, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Gerdhem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D005342:Fibrinolysis; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007405:Intervertebral Disc Displacement / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D011446:Prospective Studies; D012585:Sciatica / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Fibrinolysis; Inflammation; Lumbar disc herniation; Surgical outcome