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PMN elastase in bone and joint infections
K M Peters1, K Koberg, T Rosendahl
1Department of Orthopaedic Surgery, RWTH, Aachen, Germany.
Abstract:
PMN (polymorphonuclear neutrophil) elastase is a proteolytic enzyme which is a biochemical marker for abnormal granulocyte stimulation. In inflammation and sepsis, excessive neutrophil stimulation results in significant amounts of PMN elastase being released into the plasma which indicates the severity of the disease and its prognosis. In 62 patients with osteomyelitis or suppurative arthritis, PMN elastase had a diagnostic sensitivity of 81%, which is comparable to the nonspecific erythrocyte sedimentation rate. Sensitivity of C-reactive protein (CRP) was 71%, fibrinogen 54% and leucocyte count 26%. PMN elastase was also useful in the follow up of patients with bone and joint infections; in the early post-operative period it became normal more quickly than the other findings unless the patients developed complications. Ten days after operation, PMN elastase was normal in 75% of the patients compared to the CRP which became normal in only 25%. Later both results were similar: on discharge from hospital, PMN elastase was normal in 77% and CRP in 71%.
Insights
Polymorphonuclear neutrophil (PMN) elastase is a valuable marker for inflammation and sepsis severity. Elevated PMN elastase levels in patients with bone and joint infections indicate disease severity and aid in post-operative monitoring.
Area of Science:
- Biochemistry
- Immunology
- Clinical Diagnostics
Background:
- Polymorphonuclear neutrophil (PMN) elastase is a proteolytic enzyme.
- It serves as a biochemical marker for abnormal granulocyte stimulation.
- Elevated PMN elastase in plasma indicates disease severity and prognosis in inflammation and sepsis.
Purpose of the Study:
- To evaluate the diagnostic utility of PMN elastase in bone and joint infections.
- To assess the role of PMN elastase in monitoring treatment response and complications.
- To compare PMN elastase with other inflammatory markers like CRP, fibrinogen, and leucocyte count.
Main Methods:
- Study included 62 patients diagnosed with osteomyelitis or suppurative arthritis.
- Diagnostic sensitivity of PMN elastase was compared against erythrocyte sedimentation rate, C-reactive protein (CRP), fibrinogen, and leucocyte count.
- PMN elastase levels were monitored during the post-operative period to assess recovery and detect complications.
Main Results:
- PMN elastase demonstrated a diagnostic sensitivity of 81% in bone and joint infections, comparable to erythrocyte sedimentation rate.
- Its sensitivity surpassed that of CRP (71%), fibrinogen (54%), and leucocyte count (26%).
- Post-operatively, PMN elastase normalized faster than CRP, especially in uncomplicated cases, indicating its utility in early follow-up.
Conclusions:
- PMN elastase is a sensitive and useful marker for diagnosing bone and joint infections.
- It provides valuable insights into disease severity and prognosis.
- PMN elastase aids in effective post-operative monitoring, detecting complications earlier than other markers.