Abstract
BackgroundThere is still a challenge in discriminating between vertebral osteomyelitis and degenerative diseases of the spine. To this end, we determined the suitability of soluble urokinase-type plasminogen activator receptor (suPAR) and compared the diagnostic potential of suPAR to CRP.MethodsPatients underwent surgical stabilization of the lumbar and/or thoracic spine with removal of one or more affected intervertebral discs, as therapy for vertebral osteomyelitis (n = 16) or for erosive osteochondrosis (control group, n = 20). In this prospective study, we evaluated the suPAR and CRP levels before (pre-OP) and after surgery (post-OP) on days 3–5, 6–11, 40–56, and 63–142.ResultsThe suPAR levels in vertebral osteomyelitis patients were significantly higher than those from controls pre-OP, 3–5 days post-OP, and 6–11 days post-OP. Significantly higher CRP levels were observed in the vertebral osteomyelitis group than in the controls pre-OP and 6–11 days post-OP. Levels of suPAR and CRP correlated positively in all patients in the pre-OP period: r = 0.63 (95% CI: 0.37–0.79), p < 0.0001. The values for the area under the receiver operating characteristics curve (AUC) for pre-OP and the overall model post-OP were 0.88 (95% CI: 0.76–1.00) and 0.84 (95% CI: 0.71–0.97) for suPAR, 0.93 (95% CI: 0.85–1.00) and 0.77 (95% CI: 0.62–0.93) for CRP, and 0.98 (95% CI: 0.96–1.00) and 0.91 (95% CI: 0.82–1.00) for the combination of suPAR and CRP. The AUC for suPAR pre-OP revealed an optimum cut-off value, sensitivity, specificity, NPV, and PPV of 2.96 ng/mL, 0.69, 1.00, 0.80, and 1.00, respectively. For CRP, these values were 11.58 mg/L, 0.88, 0.90, 0.90, and 0.88, respectively.ConclusionThe present results show that CRP is more sensitive than suPAR whereas suPAR is more specific than CRP. Moreso, our study demonstrated that improvement in the diagnostic power for discrimination of vertebral osteomyelitis and degenerative diseases of the spine can be achieved by a combination of both suPAR and CRP.Trial registrationClinicalTrials.gov, NCT02554227, posted Sept. 18, 2015, and updated Aug. 13, 2019
Highlights
Vertebral osteomyelitis is a primary infection of the endplates of the vertebral bodies with secondary infection of the adjacent intervertebral discs [1]
Mean values of soluble urokinase-type plasminogen activator receptor (suPAR) concentrations ranged from 3.61 ± 0.33 (3–5 days post-OP) to 4.78 ± 0.54 ng/mL (40–56 days post-OP) in vertebral osteomyelitis patients while these values were 2.65 ± 0.22 to
The current results show that suPAR is a suitable adjunct biomarker to Creactive protein (CRP) for diagnosing vertebral with respect to suPAR (a) and CRP (b) each stratified by the interval pre-OP, post-OP, and all post-OP intervals combined
Summary
Vertebral osteomyelitis is a primary infection of the endplates of the vertebral bodies with secondary infection of the adjacent intervertebral discs [1]. The overall incidence rate of vertebral osteomyelitis increased from 0.5 cases per 100, person years 1978–1982 to 2.2 in 1995 and 5.8 in. Given that current markers including leucocyte count, erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) are unspecific, several weeks may elapse between the first symptoms and the final diagnosis of vertebral osteomyelitis [3, 7]. There is still a challenge in discriminating between vertebral osteomyelitis and degenerative diseases of the spine. To this end, we determined the suitability of soluble urokinase-type plasminogen activator receptor (suPAR) and compared the diagnostic potential of suPAR to CRP
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