Conway Janet D, Hambardzumyan Vache, Patel Nirav G, Giacobbe Shawn D, Gesheff Martin G
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Armenian-American Wellness Center, Yerevan, Armenia.
J Bone Jt Infect. 2021 Dec 1;6(9):433-441. doi: 10.5194/jbji-6-433-2021. eCollection 2021.
: Cierny-Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the "true" host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. : Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny-Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. : Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts ( ). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures ( ). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection ( ). : Adding immunologic evaluation to the Cierny-Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.
Cierny-Mader骨髓炎分类用于根据合并症将宿主标记为A、B或C型。本研究的目的是使用血清学标志物来量化骨科感染患者在活跃感染期间免疫系统的功能，从而确定其“真正的”宿主状态。
回顾性病历审查确定了在一位外科医生处就诊的患者，这些患者在2013年9月至2020年3月期间被诊断为骨科感染且有免疫学实验室检查结果。所有患者均为接受手术以根除感染的A或B型宿主。记录了病史、体格检查和Cierny-Mader分类。实验室检查结果包括总补体、C3、C4、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、免疫球蛋白A（IgA）、免疫球蛋白E（IgE）、类风湿因子和抗中性粒细胞胞浆抗体（ANCA）检测。具有临床意义的结果被定义为标记异常。当存在感染时，正常的补体水平和正常的IgG水平被视为异常。
在105例患者中，99例（94%）有实验室异常记录。在34例A型宿主中的33例（97%）和71例B型宿主中的66例（93%）发现了具有临床意义的异常。105例患者中有11例（10.5%）被血液科医生正式诊断为原发性免疫缺陷。在感染情况下，IgG缺乏（低值或正常）在91%（34例中的30例）的A型宿主和86%（71例中的56例）的B型宿主中存在。6例（5.7%）患者接受了IgG替代治疗。28例患者总补体水平异常（低或正常）：7.4%（34例中的2例）的A型宿主和40%（71例中的26例）的B型宿主（ ）。B型宿主的补体水平在统计学上显著较低，无生长培养物显著更多（ ）。14例复发性感染患者中有13例IgG水平低或正常。复发性感染患者与未复发性感染患者之间的IgM水平显著较低（ ）。
在Cierny-Mader分类中增加免疫学评估可以更准确地确定患者的真正宿主状态，并更好地量化骨科感染的风险和预后。免疫缺陷的A型宿主应被量化为B型宿主。当咨询血液科医生/免疫科医生认为适当时，可以解决IgG缺乏问题。复发性感染患者的IgM水平明显低于非复发性感染患者。
