Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases

Abstract

Background: The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation. Methods: We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available. Results: Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%). Discussion: C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.

Neutrophil to Lymphocyte Ratio: a useful predictor of amputation in patients with Necrotizing fasciitis: Diagnostic accuracy study

“…In a study on hand osteomyelitis, Wyman et al found C-reactive protein(CRP) to be the most sensitive marker and a CRP value greater than 100 mg/L was found strongly associated with sepsis. Total leucocyte count, NLR and also PLR were found to be of limited usefulness in this series [45].…”

Diagnostic Value of the Blood Neutrophil-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio in Tibia Fracture-Related Infection

“…Previous studies had addressed the role of NLR, MLR, and PLR in infections and characterized the clinical prediction potential for bacterial infection and nonspecific infection [ 10 – 14 ]. In terms of research related to bone infections, these immune-related biomarkers, such as WBCs, CRP, ESR, NLR, MLR, and PLR, are increasingly being evaluated for their abilities of fast and early diagnosis of osteomyelitis and to predict complications [ 26 – 28 , 36 – 38 ]. In diabetic foot infection patients, PLR was significantly higher in osteomyelitis, and the cut-off value PLR > 187.3 had a sensitivity of 67.9% and a specificity of 59.1% in predicting osteomyelitis [ 14 ].…”

“…Early postoperative NLR may help to recognize postoperative delirium in elderly patients undergoing surgery for lower limb fracture under nongeneral anaesthesia [ 25 ]. On the other hand, the predictive value of these markers for the prognosis of hand osteomyelitis, surgical site infection after spinal instrumentation surgery, and periprosthetic joint infection following total hip arthroplasty also needs to be further studied [ 26 – 28 ].…”

Hand Osteomyelitis in Patients With Secondary Raynaud Phenomenon

“…Our study also highlights the potential challenges in establishing the diagnosis of hand OM in SRP. Clinicians cannot always rely upon elevated inflammatory markers (ie, CRP), 8 and established radiographic abnormalities may not be present at baseline. Our study also benchmarks the high morbidity and poor outcome, including the potential need for partial digital amputation, from hand OM in SRP.…”

“…The median (interquartile range [IQR]) age of patients was 61 (8) years, and with 4 males (57%) and 3 females (43%), these proportions were comparable to a larger cohort of hand OM patients. 7 Most (n = 6) of the patients had connective tissue diseaseassociated RP with the majority within the SSc spectrum of disorders (n = 5) and 1 patient with polymyositis, with a range of ANA patterns: anticentromere (n = 2, 29%), fine speckled (n = 1, 14%), coarse speckled (n = 1, 14%), and a speckled and nucleolar pattern (n = 1, 14%). Extractable nuclear antigen was positive in 3 patients (43%), including 1 patient with RNA polymerase III positive.…”