Related Experiment Videos
[PMN-elastase as a marker in diagnosis and follow-up of bone and joint infections]
K M Peters1, K Koberg, H Kehren
1Orthopädische Klinik, Medizinische Einrichtungen der RWTH Aachen.
Abstract:
PMN elastase, a proteolytic enzyme, is a biochemical marker for pathologic granulocyte stimulation. In the presence of sepsis, excessive neutrophil stimulation occurs and significant amounts of PMN elastase are released into the plasma and serve as an indicator for the severity of the disease and the prognosis. PMN elastase is also a useful parameter for preoperative diagnostic management and postoperative follow-up of bone and joint infections. In patients with osteomyelitis and joint empyema (n = 48) PMN elastase had a sensitivity of 77%, which was only exceeded by that of the unspecific erythrocyte sedimentation rate (sensitivity 89%). Sensitivities of other inflammation parameters were lower: C-reactive protein (CRP) 67%, fibrinogen 50%, neopterin 32% and leukocyte count 21%. Determination of PMN elastase levels was also helpful in postoperative follow-up of patients with bone and joint infections. In the early postoperative period PMN elastase levels normalized more quickly than the other parameters unless patients actually developed complications. At the first postoperative determination (day 2-4 after surgery) 38% of the patients (n = 24) already had PMN elastase levels within the normal range (less than or equal to 40 micrograms/l) (CRP 13%). After 10 days PMN elastase was normal in 57% and CRP in 30% of the patients. Later on both parameters reacted similarly: by the time of discharge from hospital levels of PMN elastase were normal in 70% and CRP levels in 74%.
Insights
Polymorphonuclear (PMN) elastase is a valuable biomarker for diagnosing bone and joint infections and monitoring treatment. It normalizes faster than C-reactive protein (CRP) post-surgery, aiding in complication detection.
Area of Science:
- Biochemistry
- Immunology
- Clinical Diagnostics
Context:
- Sepsis involves excessive neutrophil stimulation, releasing polymorphonuclear (PMN) elastase into plasma.
- PMN elastase serves as a marker for disease severity and prognosis in sepsis.
- It is also a key parameter in managing bone and joint infections.
Purpose:
- To evaluate the diagnostic and prognostic utility of PMN elastase in bone and joint infections.
- To compare the efficacy of PMN elastase with other inflammatory markers like CRP and erythrocyte sedimentation rate.
- To assess the role of PMN elastase in postoperative follow-up.
Summary:
- In osteomyelitis and joint empyema, PMN elastase showed 77% sensitivity, second only to erythrocyte sedimentation rate (89%).
- PMN elastase normalized more rapidly than CRP in the early postoperative period, indicating its utility in detecting complications.
- Post-surgery, PMN elastase levels normalized quicker than CRP, with 70% of patients showing normal levels by discharge compared to 74% for CRP.
Impact:
- PMN elastase offers a sensitive diagnostic tool for bone and joint infections.
- Its rapid normalization post-surgery aids in early complication detection and patient management.
- This marker provides valuable insights into disease severity and treatment response.