Wang Zhen, Mao Haijun, Xu Guangyue
Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
J Orthop Surg Res. 2022 Oct 29;17(1):471. doi: 10.1186/s13018-022-03363-3.
Accurate preoperative diagnosis of infected nonunion remains a challenge. Here, we evaluated the diagnostic potential of novel biomarkers for infected nonunion.
A cohort of 275 patients who underwent surgery for suspected septic nonunion after open reduction and internal fixation were enrolled. Preoperatively analyzed clinical parameters included white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, globulin, albumin-to-globulin ratio (AGR), plasma D-dimer, plasma fibrinogen, platelet count (PC), monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Receiver operating characteristic (ROC) curves, sensitivity, and specificity were utilized to compare the diagnostic potential of those biomarkers.
The WBC count and levels of CRP, ESR, NLR, MLR, PLR, PC, plasma D-dimer, plasma fibrinogen, and globulin in infected nonunion patients were significantly higher (p < 0.05) than those in aseptic patients. The albumin and AGR levels of the infected nonunion group were significantly lower (p < 0.05) than the aseptic group. The ROC curve analysis showed that the diagnostic accuracy of AGR and plasma fibrinogen was good. The combination of AGR with plasma fibrinogen had the highest area under the curve (AUC) (0.916). The sensitivity and specificity were 70.27% and 91.04% for AGR, and 67.57% and 84.08% for plasma fibrinogen, respectively. The combination of AGR with plasma fibrinogen showed a sensitivity of 86.49% and specificity of 92.54%. In patients with comorbidities, the diagnostic accuracy of the combination of AGR with plasma fibrinogen was also good.
AGR and plasma fibrinogen are promising biomarkers to improve the diagnosis of infected nonunion. The combination of AGR with plasma fibrinogen is a sensitive tool for screening infected nonunion.
感染性骨不连的术前准确诊断仍然是一项挑战。在此，我们评估了新型生物标志物对感染性骨不连的诊断潜力。
纳入275例因切开复位内固定术后疑似感染性骨不连而接受手术的患者。术前分析的临床参数包括白细胞（WBC）计数、C反应蛋白（CRP）、红细胞沉降率（ESR）、白蛋白、球蛋白、白蛋白与球蛋白比值（AGR）、血浆D-二聚体、血浆纤维蛋白原、血小板计数（PC）、单核细胞与淋巴细胞比值（MLR）、中性粒细胞与淋巴细胞比值（NLR）以及血小板与淋巴细胞比值（PLR）。利用受试者工作特征（ROC）曲线、敏感性和特异性来比较这些生物标志物的诊断潜力。
感染性骨不连患者的白细胞计数、CRP、ESR、NLR、MLR、PLR、PC、血浆D-二聚体、血浆纤维蛋白原和球蛋白水平显著高于无菌性骨不连患者（p < 0.05）。感染性骨不连组的白蛋白和AGR水平显著低于无菌性骨不连组（p < 0.05）。ROC曲线分析表明，AGR和血浆纤维蛋白原的诊断准确性良好。AGR与血浆纤维蛋白原联合使用时曲线下面积（AUC）最高（0.916）。AGR的敏感性和特异性分别为70.27%和91.04%，血浆纤维蛋白原的敏感性和特异性分别为67.57%和84.08%。AGR与血浆纤维蛋白原联合使用时敏感性为86.49%，特异性为92.54%。在合并症患者中，AGR与血浆纤维蛋白原联合使用的诊断准确性也良好。
AGR和血浆纤维蛋白原是有望改善感染性骨不连诊断的生物标志物。AGR与血浆纤维蛋白原联合使用是筛查感染性骨不连的敏感工具。
