Abstract：
BACKGROUND: In absence of frank purulence, wound cultures represent \'gold-standard\' for diagnosis of fracture related infection (FRI). However, these are time-intensive, and may be falsely negative, necessitating the need for accurate and rapid biomarker-based diagnosis. We conducted this study to determine the accuracy of 3 wound-based biomarkers for the diagnosis of FRI.
METHODS: This was a prospective cohort study on adult patients who underwent an operative procedure for an upper or lower limb fracture. Wound fluid levels of alpha-defensin (AD), neutrophil elastase (NE) and IL-6 were evaluated on post-operative day 2, and patients were followed up for one month. Patients were categorized as cases (FRI) or controls (no FRI), on the basis of the consensus definition of FRI. Univariate analysis, along with receiver operating characteristic (ROC) analysis was performed.
RESULTS: 48 patients were included. AD levels showed a 2.6-fold elevation in cases (n = 26, Median = 23.74 µg/ml) as compared to controls (n = 22, Median = 8.78 µg/ml). The area under the curve for this variable was 0.71 (95% Confidence Intervals = 0.56 - 0.86). The levels of NE and IL-6 were not significantly different between cases and controls.
CONCLUSIONS: Wound AD levels are significantly elevated in patients with FRI. However, these results need to be validated in a larger cohort of patients before it can be used as a biomarker of FRI.
METHODS: This was a prospective cohort study on adult patients who underwent an operative procedure for an upper or lower limb fracture. Wound fluid levels of alpha-defensin (AD), neutrophil elastase (NE) and IL-6 were evaluated on post-operative day 2, and patients were followed up for one month. Patients were categorized as cases (FRI) or controls (no FRI), on the basis of the consensus definition of FRI. Univariate analysis, along with receiver operating characteristic (ROC) analysis was performed.
RESULTS: 48 patients were included. AD levels showed a 2.6-fold elevation in cases (n = 26, Median = 23.74 µg/ml) as compared to controls (n = 22, Median = 8.78 µg/ml). The area under the curve for this variable was 0.71 (95% Confidence Intervals = 0.56 - 0.86). The levels of NE and IL-6 were not significantly different between cases and controls.
CONCLUSIONS: Wound AD levels are significantly elevated in patients with FRI. However, these results need to be validated in a larger cohort of patients before it can be used as a biomarker of FRI.
摘要：
背景：在没有坦率的净化的情况下，伤口培养是诊断骨折相关感染(FRI)的“金标准”。然而,这些都是耗时的，可能是假阴性的，需要准确和快速的基于生物标志物的诊断。我们进行了这项研究，以确定3种基于伤口的生物标志物诊断FRI的准确性。
方法：这是一项对上肢或下肢骨折行手术治疗的成年患者进行的前瞻性队列研究。α-防御素（AD）的伤口液水平，术后第2天评估中性粒细胞弹性蛋白酶（NE）和IL-6，并随访1个月。患者分为病例（FRI）或对照（无FRI），在FRI共识定义的基础上。单变量分析,同时进行接收器工作特性(ROC)分析。
结果：纳入48例患者。与对照组（n=22，中位数=8.78µg/ml）相比，病例中的AD水平升高了2.6倍（n=26，中位数=23.74µg/ml）。该变量的曲线下面积为0.71(95%置信区间=0.56-0.86)。NE和IL-6的水平在病例和对照组之间没有显着差异。
结论：FRI患者的创伤AD水平显著升高。然而,这些结果需要在更大的患者队列中进行验证,然后才能将其用作FRI的生物标志物.
方法：这是一项对上肢或下肢骨折行手术治疗的成年患者进行的前瞻性队列研究。α-防御素（AD）的伤口液水平，术后第2天评估中性粒细胞弹性蛋白酶（NE）和IL-6，并随访1个月。患者分为病例（FRI）或对照（无FRI），在FRI共识定义的基础上。单变量分析,同时进行接收器工作特性(ROC)分析。
结果：纳入48例患者。与对照组（n=22，中位数=8.78µg/ml）相比，病例中的AD水平升高了2.6倍（n=26，中位数=23.74µg/ml）。该变量的曲线下面积为0.71(95%置信区间=0.56-0.86)。NE和IL-6的水平在病例和对照组之间没有显着差异。
结论：FRI患者的创伤AD水平显著升高。然而,这些结果需要在更大的患者队列中进行验证,然后才能将其用作FRI的生物标志物.
