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Wyman M, Dargan D, Kazzazi D, Caddick J, Giblin V. Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases. Hand (N Y) 2023; 18:987-993. [PMID: 35130740 PMCID: PMC10470241 DOI: 10.1177/15589447211066346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation. METHODS We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available. RESULTS Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%). CONCLUSION C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.
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Affiliation(s)
- Matthew Wyman
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
| | - Dallan Dargan
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
| | - Diana Kazzazi
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Victoria Giblin
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
- The University of Sheffield, UK
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Martins D, Tonon CR, Pacca RL, Matchil NL, Junior LAJ, Queiroz DS, Pereira FWL, Silva AM, Padovese V, Padovani de Toledo Moraes M, Luiz da Silva D, Cardoso Nóbrega V, Curcelli EC, Okoshi MP. Gout Storm. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932683. [PMID: 34855717 PMCID: PMC8475732 DOI: 10.12659/ajcr.932683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 55-year-old
Final Diagnosis: Gout • spinal gout
Symptoms: Back pain • fever • incontinence • pain • paresthesia of extremities • tachycardia
Medication: —
Clinical Procedure: Antibiotics • arthrocentesis • biopsy • CT scan • surgery • ultrasonography
Specialty: General and Internal Medicine
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Affiliation(s)
- Danilo Martins
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Carolina Rodrigues Tonon
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Rafael Lopes Pacca
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Natanye Lemes Matchil
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Luiz Antonio Jorge Junior
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Dênis Silva Queiroz
- Department of Orthopedics and Traumatology, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Filipe Welson Leal Pereira
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Alana Maia Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Vinicius Padovese
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | | | - Daniel Luiz da Silva
- Department of Pathology, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Vinicius Cardoso Nóbrega
- Department of Pathology, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Emilio Carlos Curcelli
- Department of Orthopedics and Traumatology, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Marina Politi Okoshi
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil
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Imagama T, Seki K, Seki T, Tokushige A, Matsuki Y, Yamazaki K, Nakashima D, Okazaki T, Hirata K, Yamamoto M, Tanaka H, Sakai T. Synovial fluid presepsin as a novel biomarker for the rapid differential diagnosis of native joint septic arthritis from crystal arthritis. Int J Infect Dis 2020; 102:472-477. [PMID: 33278715 DOI: 10.1016/j.ijid.2020.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate whether presepsin can be used as a novel biomarker to differentiate between native joint septic arthritis (NJSA) and crystal arthritis (CA). METHODS This study included 75 patients diagnosed with either NJSA (n = 21) or CA (n = 54). Presepsin in synovial fluid and blood, C-reactive protein, and procalcitonin were measured and compared between the NJSA and CA groups. Receiver operating characteristic (ROC) curve analyses were performed to differentiate between the two groups. RESULTS Synovial fluid and blood presepsin were significantly higher in the NJSA group than in the CA group (p < 0.0001 and p < 0.01, respectively). The area under the ROC curve for synovial fluid presepsin in the NJSA group compared with the CA group was 0.93 (sensitivity 85.7%, specificity 85.2%, positive predictive value 69.2%, negative predictive value 93.9%, positive likelihood ratio 5.79, negative likelihood ratio 0.17). Among the tests, synovial fluid presepsin was the most accurate. CONCLUSIONS Measurement of synovial fluid presepsin is reliable for the early diagnosis of NJSA, and synovial fluid presepsin could be used as a novel biomarker for differentiating between NJSA and CA.
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Affiliation(s)
- Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan.
| | - Kazushige Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan
| | - Toshihiro Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan
| | - Atsunori Tokushige
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan
| | - Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan
| | - Daisuke Nakashima
- Department of Orthopedic Surgery, St. Hill Hospital, 3-7-18, Imamurakita, Ube 755-0155, Japan
| | - Tomoya Okazaki
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, 10077, Osaki, Hofu, 747-8511, Japan
| | - Kenji Hirata
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, 10077, Osaki, Hofu, 747-8511, Japan
| | - Manabu Yamamoto
- Department of Orthopedic Surgery, Tokuyama Central Hospital, 1-1, Koda, Shunan, 745-8522, Japan
| | - Hiroshi Tanaka
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, 10077, Osaki, Hofu, 747-8511, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube 755-8505, Japan
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Belov BS, Tarasova GM, Muravyeva NV. Role of biomarkers in the diagnosis of bacterial infections in rheumatic diseases. НАУЧНО-ПРАКТИЧЕСКАЯ РЕВМАТОЛОГИЯ 2019. [DOI: 10.14412/1995-4484-2019-333-338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In modern rheumatology, the problem of differential diagnosis of bacterial infection and active rheumatic process still retains its relevance. At the same time, it is very important to search for a biomarker - the gold standard for the diagnosis of an infection in patients with rheumatic diseases (RDs) in order to rapidly determine a treatment policy. This review analyzes the diagnostic significance and possibility of using some laboratory markers for bacterial infections in modern rheumatology. It emphasizes the importance of a multimarker approach that allows increasing the significance of individual parameters in the diagnosis of infections in RD.
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Affiliation(s)
- B. S. Belov
- V.A. Nasonova Research Institute of Rheumatology
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