AZU1: a new promising marker for infection in orthopedic and trauma patients?

Authors

  • Philipp Hemmann Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany https://orcid.org/0000-0002-0535-5359
  • Lisa Kloppenburg Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0009-0009-9914-9668
  • Regina Breinbauer Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0009-0001-7172-9443
  • Sabrina Ehnert Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0000-0003-4347-1702
  • Gunnar Blumenstock Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany https://orcid.org/0000-0002-0129-4827
  • Marie K. Reumann Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany; Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0000-0002-2753-4411
  • Felix Erne Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany; Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0000-0002-0877-9018
  • Johann Jazewitsch Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University TuebingenSiegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0009-0000-7267-4870
  • Tobias Schwarz Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany https://orcid.org/0009-0006-5263-7371
  • Heiko Baumgartner Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany https://orcid.org/0000-0003-1092-6918
  • Tina Histing Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany https://orcid.org/0000-0002-6955-2001
  • Mika Rollmann Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany https://orcid.org/0000-0002-0001-538X
  • Andreas K. Nüssler Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany. E-mail: andreas.nuessler@med.uni-tuebingen.de https://orcid.org/0000-0002-6666-6791

DOI:

https://doi.org/10.17179/excli2023-6705

Keywords:

AZU1, HBP, orthopedic surgery, infection, trauma surgery

Abstract

Early and reliable detection of infection is vital for successful treatment. Serum markers such as C-reactive protein (CRP) and procalcitonin (PCT) are known to increase with a time lag. Azurocidin 1 (AZU1) has emerged as a promising marker for septic patients, but its diagnostic value in orthopedic and trauma patients remains unexplored. Between July 2020 and August 2023, all patients necessitating inpatient treatment for periprosthetic joint infection (PJI), peri-implant infection (II), soft tissue infection, chronic osteomyelitis, septic arthrodesis, bone non-union with and without infection were enrolled. Patients undergoing elective total joint arthroplasty (TJA) served as the control group. Blood samples were collected and analyzed for CRP, white blood cell count (WBC), PCT, and AZU1. Based on the inclusion and exclusion criteria 222 patients were included in the study (trauma = 38, soft tissue infection = 75, TJA = 33, PJI/II = 39, others = 37). While sensitivity and specificity were comparably high for AZU1 (0.734/0.833), CRP and PCT had higher specificity (0.542/1 and 0.431/1, respectively), and WBC a slightly higher sensitivity (0.814/0.455) for septic conditions. Taken together, the area under the curve (AUC) showed the highest accuracy for AZU1 (0.790), followed by CRP (0.776), WBC (0.641), and PCT (0.656). The Youden-Index was 0.57 for AZU1, 0.54 for CRP, 0.27 for WBC, and 0.43 for PCT. Elevated AZU1 levels effectively distinguished patients with a healthy condition from those suffering from infection. However, there is evidence suggesting that trauma may influence the release of AZU1. Additional research is needed to validate the diagnostic value of this new biomarker and further explore its potential clinical applications.

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Published

2024-01-03

How to Cite

Hemmann, P., Kloppenburg, L., Breinbauer, R., Ehnert, S., Blumenstock, G., Reumann, M. K., … Nüssler, A. K. (2024). AZU1: a new promising marker for infection in orthopedic and trauma patients?. EXCLI Journal, 23, 53–61. https://doi.org/10.17179/excli2023-6705

Issue

Vol. 23 (2024)

Section

Original articles

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Copyright (c) 2024 Philipp Hemmann, Lisa Kloppenburg, Regina Breinbauer, Sabrina Ehnert, Gunnar Blumenstock, Marie K. Reumann, Felix Erne, Johann Jazewitsch, Tobias Schwarz, Heiko Baumgartner, Tina Histing, Mika Rollmann, Andreas K. Nüssler

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