Predictive ability of inflammatory markers and laboratory parameters in Legg-Calvé-Perthes disease

Abstract

Legg-Calvé-Perthes disease (LCPD) presents with chronic nature of inflammation, characterized by prolonged synovitis. So far, no single blood marker has been identified to guide clinicians in estimating the severity and prognosis. Blood neutrophil to lymphocyte ratio (NLR) or systemic immune inflammation index (SII) is a simple indicator of subclinical inflammation. This study aims to examine the predictive ability of NLR, SII, and common laboratory parameters for estimating the severity of LCPD. The pre-operative laboratory findings at the time of osteotomy and implant removal in patients with unilateral LCPD who had been treated with the Salter innominate osteotomy and followed up until skeletal maturity as well as those of age-matched control patients with idiopathic noninflammatory conditions were analyzed. The datasets of 26 or 38 LCPD patients at the time of osteotomy or implant removal, respectively, and those of 20 control patients were available for analysis. At the time of osteotomy, compared to the control group, a significantly higher mean NLR or SII and a significantly lower mean alkaline phosphatase value were observed in the LCPD group. The alkaline phosphatase levels of patients with the modified lateral pillar (LP) group-A hips were significantly lower than those with the non-LP-A hips, whereas no significant differences were observed in any of the parameters between patients with favorable LP-A or -B hips and those with unfavorable LP-BjC border or -C hips. In agreement with the conventional opinion, it may be difficult to predict a meaningful prognosis of LCPD with the use of inflammatory markers or common laboratory parameters obtained in the initial stage of the disease.

Doença de Legg-Calvé-Perthes: uma abordagem diagnóstica, evolução clínica e revisão

“…A DLCP é a osteonecrose juvenil da região proximal do fêmur, principalmente da cabeça femoral, após manifestação isquêmica única ou repetida. O acometimento da cabeça femoral nas fases mais tardias da doença pode deixar vários graus de deformidade, afetando a saúde física e mental da criança (MISHIMA et al, 2022;WANG et al, 2023).…”

“…Brazilian Journal of Health Review, Curitiba, v. 6, n. 5, p.21904-21913, sep./oct., 2023 Embora a etiologia relativa ao evento isquêmico permaneça pouco compreendida tanto em relação à causa, à evolução e ao tratamento, implicações potenciais de coagulação subclínica e anormalidades lipídicas foram documentadas (MISHIMA et al, 2022).…”

“…(GONÇALVES et al, 2020, p. 3). Mishima et al (2022) investigaram a capacidade preditiva de NLR (proporção entre neutrófilos e linfócitos), SII (índice de inflamação imune sistêmica) e nível de fosfatase alcalina (ALP), obtidos a partir de testes laboratoriais comuns, para estimar a gravidade da DLCP, ou seja, para a predição do prognóstico em pacientes submetidos à terapia de contenção cirúrgica na fase ativa da doença. Eles concluíram que os valores de NLR, SII e ALP no estágio inicial da doença, parecem refletir as características clínicas da DLCP, como inflamação local prolongada e maturação esquelética retardada.…”