Division of Orthopaedics & Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China.
Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China.
Dis Markers. 2021 Oct 28;2021:6196663. doi: 10.1155/2021/6196663. eCollection 2021.
A previous study had reported that patients with osteomyelitis (OM) appeared to be more likely to develop hypocalcemia before and after surgery. Calcium sulfate (CS) is frequently used as a local antibiotic vehicle in the treatment of OM, which may also affect serum calcium level. However, whether changes of serum calcium level are caused by OM and/or local use of calcium sulfate remains unclear. Also, platelet (PLT) count plays a crucial predictive role in periprosthetic joint infections (PJIs), but its role in assisted diagnosis of OM is largely unknown. The purpose of this study was to determine whether serum calcium level and PLT count may be helpful in assisted diagnosis of PTOM.
Between January 2013 and December 2018, we analyzed 468 consecutive patients (392 males and 76 females), including 170 patients with posttraumatic OM (PTOM), 130 patients with aseptic bone nonunion (ABN), and 168 patients recovered from fractures with requirement of implant removal set as controls. Preoperative serological levels of calcium, phosphorus, and PLT were detected, and comparisons were conducted among the above three groups. Additionally, correlations and receiver operating characteristic (ROC) curves were displayed to test whether calcium level and PLT can differentiate patients with ABN and PTOM.
Outcomes showed that the incidences of asymptomatic hypocalcemia (PTOM vs. ABN vs. controls = 22.94% vs. 6.92% vs. 8.82%, = 21.098, < 0.001) and thrombocytosis (PTOM vs. ABN vs. controls = 35.3% vs. 13.84% vs. 12.35%, = 28.512, < 0.001) were highest in PTOM patients. Besides, the mean serological levels of phosphorus in PTOM and ABN patients were significantly higher than those in the controls ( = 0.007). The Area Under the Curve (AUC) of the ROC curve outcomes revealed that, with the combination of serum calcium level with PLT count, the predictive role was acceptable (AUC 0.730, < 0.001, 95% CI 0.681-0.780). Also, serological levels of calcium of 2.225 mmol/L and PLT count of 246.5 × 10/L were identified as the optimal cut-off values to distinguish patients with and without PTOM. However, age- and gender-related differences in serum calcium levels (age, = 0.056; gender, = 0.978) and PLT count (age, = 0.363; gender, = 0.799) were not found to be statistically significant in any groups. In addition, no significant correlations were identified between serum calcium level and PLT count ( = 0.010, = 0.839).
Asymptomatic hypocalcemia and thrombocytosis appeared to be more frequent in this cohort with PTOM. Serological levels of calcium and PLT count may be useful biomarkers in screening patients suspected of PTOM.
先前的研究表明，骨髓炎（OM）患者在手术前后似乎更容易出现低钙血症。硫酸钙（CS）常被用作治疗 OM 的局部抗生素载体，这也可能影响血清钙水平。然而，血清钙水平的变化是由 OM 和/或局部使用硫酸钙引起的，目前仍不清楚。此外，血小板（PLT）计数在假体周围关节感染（PJIs）的预测中起着至关重要的作用，但它在 OM 辅助诊断中的作用在很大程度上是未知的。本研究旨在确定血清钙水平和 PLT 计数是否有助于 OM 的辅助诊断。
2013 年 1 月至 2018 年 12 月，我们分析了 468 例连续患者（392 名男性和 76 名女性），包括 170 例创伤后骨髓炎（PTOM）患者、130 例无菌性骨不连（ABN）患者和 168 例骨折愈合后需要取出植入物的患者作为对照。检测了术前血清钙、磷和 PLT 水平，并对上述三组进行了比较。此外，还显示了相关性和受试者工作特征（ROC）曲线，以测试钙水平和 PLT 是否可以区分 ABN 和 PTOM 患者。
结果显示，无症状低钙血症（PTOM 与 ABN 与对照组=22.94%与 6.92%与 8.82%，=21.098，<0.001）和血小板增多症（PTOM 与 ABN 与对照组=35.3%与 13.84%与 12.35%，=28.512，<0.001）在 PTOM 患者中发生率最高。此外，PTOM 和 ABN 患者的血清磷平均水平明显高于对照组（=0.007）。ROC 曲线结果的曲线下面积（AUC）显示，血清钙水平与 PLT 计数相结合的预测作用是可以接受的（AUC 0.730，<0.001，95%CI 0.681-0.780）。此外，血清钙水平为 2.225 mmol/L 和 PLT 计数为 246.5×10/L 被确定为区分有无 PTOM 患者的最佳截断值。然而，各组血清钙水平（年龄，=0.056；性别，=0.978）和 PLT 计数（年龄，=0.363；性别，=0.799）的年龄和性别差异均无统计学意义。此外，血清钙水平与 PLT 计数之间未发现显著相关性（=0.010，=0.839）。
本队列中，PTOM 患者出现无症状低钙血症和血小板增多症的可能性似乎更大。血清钙和 PLT 计数可能是筛查疑似 PTOM 患者的有用生物标志物。
