The role of inflammatory markers in sequential osteosynthesis of gunshot fractures of extremity bones: a prospective study

Background: the search for reliable diagnostic laboratory markers of the development of infectious and inflammatory processes is an urgent topic for scientific research. At the same time, the sensitivity and specificity indicators of currently used biomarkers of inflammation are often insufficient for timely decision-making in the treatment of patients at risk of developing such complications. To date, there is evidence of the use of a fragment of the CD14 transmembrane protein presepsin (PSP) as a new biomarker of infectious complications, which has almost 100% sensitivity and 98% specificity, which can be successfully used in predicting the risk of developing infectious complications in the postoperative period.

Objective: the aim of this clinical study is to compare the value of presepsin with traditional laboratory markers of inflammation in predicting the risk of infectious complications after sequential osteosynthesis of gunshot fractures of long tubular bones.

Materials and methods: in 113 wounded, we determined the following parameters: C-reactive protein (CRP), procalcitonin (PCT), PSP, erythrocyte sedimentation rate (ESR) and the number of leukocytes in serum/plasma. The prognostic characteristics of laboratory markers were evaluated based on the use of concentration thresholds obtained during the study of biomarkers. The prognostic value of the level of all analyzed biomarkers in relation to the occurrence of infectious complications was assessed by sensitivity and specificity based on ROC analysis and determination of the limit values of the studied markers before and after sequential osteosynthesis surgery.

Results: based on the ROC analysis, cutoff values for CRP, PSP, PCT, ESR, and leukocyte counts were established for the study patients. Moreover, CRP and ESR demonstrated the best specificity/sensitivity ratio, while procalcitonin and presepsin demonstrated the least optimal.

Conclusion: presepsin and procalcitonin did not demonstrate significant predictive value in predicting the risk of infectious complications during sequential osteosynthesis of gunshot fractures of long tubular bones. However, CRP, ESR, and dynamic leukocyte counts in a complete blood count during the postoperative period demonstrated high predictive value.

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