Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level

<p><strong>Introduction</strong>: Cierny–Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the “true” host status of patients with orthopedic infection using serologic markers to quantify the compete...

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Autores principales:	J. D. Conway, V. Hambardzumyan, N. G. Patel, S. D. Giacobbe, M. G. Gesheff
Formato:	article
Lenguaje:	EN
Publicado:	Copernicus Publications 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/cbea882304524883a36d0942185227a4
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spelling	oai:doaj.org-article:cbea882304524883a36d0942185227a42021-12-01T07:11:08ZImmunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level10.5194/jbji-6-433-20212206-3552https://doaj.org/article/cbea882304524883a36d0942185227a42021-12-01T00:00:00Zhttps://jbji.copernicus.org/articles/6/433/2021/jbji-6-433-2021.pdfhttps://doaj.org/toc/2206-3552<p><strong>Introduction</strong>: Cierny–Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the “true” host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. <strong>Methods</strong>: Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny–Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. <strong>Results</strong>: Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts (<span class="inline-formula"><i>p</i>=0.002</span>). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures (<span class="inline-formula"><i>p</i><0.03</span>). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection (<span class="inline-formula"><i>p</i>=0.0005</span>). <strong>Conclusions</strong>: Adding immunologic evaluation to the Cierny–Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.</p>J. D. ConwayV. HambardzumyanV. HambardzumyanN. G. PatelS. D. GiacobbeM. G. GesheffCopernicus PublicationsarticleOrthopedic surgeryRD701-811ENJournal of Bone and Joint Infection, Vol 6, Pp 433-441 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 J. D. Conway V. Hambardzumyan V. Hambardzumyan N. G. Patel S. D. Giacobbe M. G. Gesheff Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
description	<p><strong>Introduction</strong>: Cierny–Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the “true” host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. <strong>Methods</strong>: Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny–Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. <strong>Results</strong>: Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts (<span class="inline-formula"><i>p</i>=0.002</span>). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures (<span class="inline-formula"><i>p</i><0.03</span>). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection (<span class="inline-formula"><i>p</i>=0.0005</span>). <strong>Conclusions</strong>: Adding immunologic evaluation to the Cierny–Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.</p>
format	article
author	J. D. Conway V. Hambardzumyan V. Hambardzumyan N. G. Patel S. D. Giacobbe M. G. Gesheff
author_facet	J. D. Conway V. Hambardzumyan V. Hambardzumyan N. G. Patel S. D. Giacobbe M. G. Gesheff
author_sort	J. D. Conway
title	Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
title_short	Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
title_full	Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
title_fullStr	Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
title_full_unstemmed	Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level
title_sort	immunological evaluation of patients with orthopedic infections: taking the cierny–mader classification to the next level
publisher	Copernicus Publications
publishDate	2021
url	https://doaj.org/article/cbea882304524883a36d0942185227a4
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Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level

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