Hemmann Philipp, Kloppenburg Lisa, Breinbauer Regina, Ehnert Sabrina, Blumenstock Gunnar, Reumann Marie K, Erne Felix, Jazewitsch Johann, Schwarz Tobias, Baumgartner Heiko, Histing Tina, Rollmann Mika, Nüssler Andreas K
Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
EXCLI J. 2024 Jan 3;23:53-61. doi: 10.17179/excli2023-6705. eCollection 2024.
Early and reliable detection of infection is vital for successful treatment. Serum markers such as C-reactive protein (CRP) and procalcitonin (PCT) are known to increase with a time lag. Azurocidin 1 (AZU1) has emerged as a promising marker for septic patients, but its diagnostic value in orthopedic and trauma patients remains unexplored. Between July 2020 and August 2023, all patients necessitating inpatient treatment for periprosthetic joint infection (PJI), peri-implant infection (II), soft tissue infection, chronic osteomyelitis, septic arthrodesis, bone non-union with and without infection were enrolled. Patients undergoing elective total joint arthroplasty (TJA) served as the control group. Blood samples were collected and analyzed for CRP, white blood cell count (WBC), PCT, and AZU1. Based on the inclusion and exclusion criteria 222 patients were included in the study (trauma = 38, soft tissue infection = 75, TJA = 33, PJI/II = 39, others = 37). While sensitivity and specificity were comparably high for AZU1 (0.734/0.833), CRP and PCT had higher specificity (0.542/1 and 0.431/1, respectively), and WBC a slightly higher sensitivity (0.814/0.455) for septic conditions. Taken together, the area under the curve (AUC) showed the highest accuracy for AZU1 (0.790), followed by CRP (0.776), WBC (0.641), and PCT (0.656). The Youden-Index was 0.57 for AZU1, 0.54 for CRP, 0.27 for WBC, and 0.43 for PCT. Elevated AZU1 levels effectively distinguished patients with a healthy condition from those suffering from infection. However, there is evidence suggesting that trauma may influence the release of AZU1. Additional research is needed to validate the diagnostic value of this new biomarker and further explore its potential clinical applications.
早期且可靠地检测感染对于成功治疗至关重要。已知血清标志物如C反应蛋白（CRP）和降钙素原（PCT）会有延迟升高。天青杀素1（AZU1）已成为脓毒症患者有前景的标志物，但其在骨科和创伤患者中的诊断价值仍未得到探索。在2020年7月至2023年8月期间，纳入了所有因假体周围关节感染（PJI）、植入物周围感染（II）、软组织感染、慢性骨髓炎、脓毒性关节固定术、有无感染的骨不连而需要住院治疗的患者。接受择期全关节置换术（TJA）的患者作为对照组。采集血样并分析CRP、白细胞计数（WBC）、PCT和AZU1。根据纳入和排除标准，222例患者被纳入研究（创伤 = 38例，软组织感染 = 75例，TJA = 33例，PJI/II = 39例，其他 = 37例）。虽然AZU1的敏感性和特异性相对较高（分别为0.734/0.833），但CRP和PCT具有更高的特异性（分别为0.542/1和0.431/1），而WBC对脓毒症情况的敏感性略高（0.814/0.455）。总体而言，曲线下面积（AUC）显示AZU1的准确性最高（0.790），其次是CRP（0.776）、WBC（0.641）和PCT（0.656）。AZU1的约登指数为0.57，CRP为,0.54，WBC为0.27，PCT为0.43。AZU1水平升高能有效区分健康患者和感染患者。然而，有证据表明创伤可能会影响AZU1的释放。需要进一步研究来验证这种新生物标志物的诊断价值，并进一步探索其潜在的临床应用。
