Can Procalcitonin Help The Diagnosis of Osteomyelitis in Adults?: A Prospective Study

Year 2017, Volume: 1 Issue: 2, 25 - 29, 12.12.2017

Hasan Karsen Emine Ayça Güler Adnan Kirmit Süleyman Yıldırım

Abstract

SUMMARY

Aim: The aim of this study was to
evaluate the sensitivity, specificity and predictive values of procalcitonin in
adults patients with osteomyelitis.

Material and Methods: A total of
30 consecutive patients with osteomyelitis and 30 healthy controls were
enrolled in this study. The white blood cell count, erythrocyte sedimentation
rate, C-reactive protein and procalcitonin (PCT) levels of the patients and
controls were detected. Procalcitonin was measured by an Enzyme-Linked
Immunosorbent Assay (Ray Bio^® Human Procalcitonin ELISA Kit, Norcross
GA, USA). Values of PCT levels >0,5 ng/ml were considered as high than
normal.

Results: Among 30 patients included in
the study 4 of them were subacute osteomyelitis while 26 of them were chronic
osteomyelitis. The ratio of the female to male both in patients and the control
group was 10/20. The mean age of the patients was 31,16 ±15,32 years, while in
control group 32,22±14.32 years. 26 (86,7%) of the patients had clinical signs
and symptoms of osteomyelitis. White blood cell count detected high in 5
(16.6%) of them, erythrocyte sedimentation rate was high in 20 (66.6%) of them
and  C-reactive protein was positive in 15 (50%) patients, but PCT levels
found to be higher in all 30 (100%) patients (PCT>0.5 ng/mL). In our study,
the PCT test, with a 0.5 ng/mL cut-off value, had a sensitivity of 100%, a
specificity of 56% and a positive predictive value of 100%. The PCT test, with
a 0.57 ng/mL cut-off value, had a sensitivity of 87%, a specificity of 86% and
a positive predictive value of 87%.  This cut-off value (0.57 ng/mL) is
quite suitable in osteomyelitis patients.

Conclusion: The sensitivity, specificity, and positive
predictive values of PCT test are more discriminative than the other acute
phase reactants in the patients with osteomyelitis. Therefore, the PCT test can
be used as a useful marker in the diagnosis of osteomyelitis.

 

Keywords

Procalcitonin, osteomyelitis

PROKALSİTONİN YETİŞKİNLERDE OSTEOMYELİT TANISINA YARDIMCI OLABİLİR Mİ?: PROSPEKTİF BİR ÇALIŞMA

Abstract

ÖZET

AMAÇ: Bu çalışmanın
amacı osteomyelit tanısı alan erişkin hastalarda prokalsitoninin duyarlılık,
özgüllük ve prediktif değerini ölçmektir.

MATERYAL VE METOD: Çalışmaya
osteomiyelitli 30 hasta ve 30 sağlıklı kontrol grubu alındı. Her iki grubun
lökosit sayısı, eritrosit sedimantasyon hızı, C-reaktif protein ve
prokalsitonin (PCT) düzeyleri saptandı. Prokalsitonin, Enzyme-Linked
Immunosorbent Assay (Ray Bio^® Human Procalcitonin LISA Kit, Norcross
GA, USA) yöntemi ile ölçüldü. PCT’nin 0,5 ng/ml'nin üzerinde olan değeri,
normalden yüksek olarak kabul edildi.

BULGULAR: Çalışmaya
dahil edilen 30 hastanın 4'ü subakut osteomyelit iken; 26'sı kronik
osteomyelitti. Hastaların ve kontrol grubundaki toplam kadınların erkeklere
oranı 10/20'ydi. Hastaların yaş ortalaması 31,16 ± 15,32 iken, kontrol grubunda
ise 32,22 ± 14,32 idi. Hastaların 26'sında (% 86,7) klinik bulgular ve
osteomyelit semptomları vardı. 5 (% 16.6) hastada lökosit sayısı yüksek, 20 (%
66.6) hastada eritrosit sedimantasyon hızı yüksek, 15 (% 50) hastada C-reaktif
protein pozitif iken 30 (% 100) hastanın tümünde PCT düzeyleri (PCT> 0.5 ng
/ mL) yüksek bulundu. Çalışmamızda, PCT testinin cut-off değeri 0.5 ng/mL
olarak değerlendirildiğinde, duyarlılığı % 100, özgüllüğü % 56 ve pozitif
prediktif değeri ise % 100 idi. PCT’nin cut-off değeri 0.57 ng/mL
değerlendirildiğinde, duyarlılığı % 87, özgüllüğü % 86 ve pozitif prediktif
değeri ise % 87 idi. Bu cut-off değeri (0.57 ng/mL), osteomyelit hastaları için
daha uygun görüldü.

SONUÇ: Osteomyelitli
hastalarda, PCT testinin duyarlılığı, özgüllüğü ve pozitif prediktif değeri
diğer akut faz reaktanlarına göre daha iyi ayırıcı tanıya götürebilmektedir. Bu
nedenle PCT testi, osteomyelitin teşhisinde yararlı bir belirteç olarak
kullanılabilir.

 

 

Keywords

prokalsitonin, osteomyelit

References

• 1. Sipahi OR. Osteomiyelit, Gündeş S.(eds). Deri, yumuşak doku, eklem ve kemik enfeksiyonları. Ankara: Bilimsel Tıp Yayınevi (in Turkish), 2008: 419-427.
• 2.Timsit S, Pannier S, Glorion C, Chéron G: Acute osteomyelitis and septic arthritis in children: one year experience. Arch Pédiatr.2005; 12:16-22 . 3. Bonhoeffer J, Haeberle B, Schaad UB, Heininger U. Diagnostic of acute haemetogenous osteomyelitis and septic arthritis: 20 years experience at the University Children's Hospital Basel. Swiss Med Wkly. 2001; 131:575-81.
• 4. Goergens ED, McEvoy A, Watson M, Barrett IR: Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005; 41:59-62.
• 5. Pourakbari B, Mamishi S, Zafari J, Khairkhah H, Ashtiani MH, Abedini M, Afsharpaiman S, Rad SS. Evaluation of procalcitonin and neopterin level in serum of patients with acute bacterial infection. Braz J Infect Dis. 2010; 14(3):252-5.
• 6. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004; 2: 206-17.
• 7. Van Nieuwkoop C, Bonten TN, Van't Wout JW, Kuijper EJ, Groeneveld GH, Becker MJ, et al. Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit Care. 2010; 14(6):R206.
• 8. Butbul-Aviel Y, Koren A, Halevy R, Sakran W. Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatr Emerg Care. 2005; 21(12):828-32.
• 9. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23(2):80-9.
• 10. Faesch S, Cojocaru B, Hennequin C, Pannier S, Glorion C, Lacour B, Chéron G. Can procalcitonin measurement help the diagnosis of osteomyelitis and septic arthritis? A prospective trial. Ital J Pediatr. 2009;35(1):33.
• 11. Zacharski LR, Kyle RA MD. Significance of extreme elevation of the erythrocyte sedimentation rate. JAMA. 1967; 202:116-8.
• 12. Bedell SE, Bush BT. Erythrocyte sedimentation rate. From folklore to facts. Am J Med. 1985;78:1000-9.
• 13. Wallach J. M.D. Interpretation of diagnostic tests. Seventh edition. Phildelphia. Lippincot Williams&Wilkins. 2000: 55-7.
• 14. Lascari AD. The erythrocyte sedimentation rate. Symposium on pediatric hematology. Ped Clin North Am. 1972;19:113-9.
• 15. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acutephase reactant for clinical practice. Eur J Clin Invest. 1996; 26:427-35.
• 16. Gauldie J, Richards C, Harnish D, et al. Interferon b2/B-cell stimulatory factor type 2 shares identity with monocyte-derived hepatocyte-stimulating factor and regulates the major acute phase protein response in liver cell. Proc Natl Acad Sci. 1987; 84:7251-5.
• 17. Choi P, Reiser H: IL-4: role in disease and regulation production: Clin Exp Immunol. 1998; 113:317-3.
• 18. Ugarte H, Silva E, Mercan D, De Mendonça A, Vincent JL. Procalcitonin used as marker of infection in the intensive care unit. Crit Care Med. 1999; 27:498-12.
• 19. Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, Piette JC, Aumaître O. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis. 2003; 62(4):337-40.
• 20. Maseda E, Gilsanz F. Duration of antibiotic therapy in intraabdominal infections [Article in Spanish]. Enferm Infecc Microbiol Clin. 2010; 2:49-52.
• 21. Hatzistilianou M. Diagnostic and prognostic role of procalcitonin in infections. ScientificWorldJournal. 2010;10:1941-6.
• 22. Eberhard OK, Haubitz M, Brunkhorst FM, et al. Usefulness of procalcitonin for differentiation between activity of systemic utoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum. 1997; 40:1250–1256.
• 23. Shin KC, Lee YJ, Kang SW, et al. Serum procalcitonin measurement for detection of intercurrent infection in febrile patients with SLE. Ann Rheum Dis. 2001; 60:988–989