{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:11:39Z","timestamp":1788757899396,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Reliable biomarkers for identifying patients at increased risk of osteomyelitis recurrence during the early postoperative period are lacking. The C-reactive protein-to-albumin ratio (CAR), which integrates systemic inflammatory burden and nutritional status, has shown diagnostic value in musculoskeletal infections, but its prognostic role after surgical treatment of osteomyelitis remains unclear. This study evaluated whether early postoperative CAR predicts osteomyelitis recurrence and compared its performance with conventional inflammatory biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 90 consecutive adults who underwent surgical treatment for osteomyelitis between January 2020 and December 2024. Serum inflammatory biomarkers were recorded before surgery and at the first postoperative outpatient visit, approximately one month after surgery. The primary outcome was osteomyelitis recurrence during a minimum follow-up of 12 months. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of inflammatory biomarkers, and multivariable logistic regression was used to evaluate factors independently associated with recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a mean follow-up of 19 months, recurrence occurred in 19 patients (21.1%). Patients with recurrence had significantly higher baseline and one-month CAR values than those without recurrence (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Among the evaluated biomarkers, one-month CAR demonstrated the numerically highest AUC for recurrence (AUC\u2009=\u20090.862; optimal cutoff\u2009=\u20091.41), with a sensitivity of 73.7% and specificity of 87.3%. However, its AUC was not significantly different from that of one-month CRP (AUC\u2009=\u20090.831; DeLong\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.223). In multivariable analysis, one-month CAR remained independently associated with recurrence within the parsimonious multivariable model (OR 5.42, 95% CI 2.38\u201312.36;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), together with the Charlson Comorbidity Index (OR 1.94, 95% CI 1.27\u20132.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Leukocyte-derived inflammatory indices showed substantially lower prognostic performance during postoperative follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early postoperative CAR was associated with osteomyelitis recurrence and showed good discriminative ability, with the numerically highest AUC among the evaluated inflammatory biomarkers. However, its discriminative performance was not statistically superior to that of one-month CRP. CAR may therefore represent a practical adjunctive biomarker for postoperative risk stratification. Prospective multicenter studies are warranted to validate these findings and determine whether CAR-guided surveillance improves patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1953342","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:24:02Z","timestamp":1788755042000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early postoperative C-reactive protein-to-albumin ratio for risk stratification of osteomyelitis recurrence after surgical treatment"],"prefix":"10.3389","volume":"13","author":[{"given":"Muhammed","family":"Kazez","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Elazig Fethi Sekin City Hospital","place":["Elazig, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Agar","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University","place":["Elazig, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sefa","family":"Key","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University","place":["Elazig, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University","place":["Elazig, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilyas","family":"Turk","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University","place":["Elazig, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/S0140-6736(04)16727-5","article-title":"Osteomyelitis","volume":"364","author":"Lew","year":"2004","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3238\/arztebl.2012.0257","article-title":"Treatment algorithms for chronic osteomyelitis","volume":"109","author":"Walter","year":"2012","journal-title":"Dtsch Arztebl Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: a consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"B4","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1","article-title":"The EBJIS definition of periprosthetic joint infection: a practical guide for clinicians","author":"McNally","year":"2021","journal-title":"Bone Joint J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"CD004439","DOI":"10.1002\/14651858.CD004439.pub3","article-title":"Antibiotics for treating chronic osteomyelitis in adults","volume":"2013","author":"Conterno","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1093\/cid\/civ482","article-title":"2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults","volume":"61","author":"Berbari","year":"2015","journal-title":"Clin Infect Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1055\/s-0029-1214160","article-title":"Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy","volume":"23","author":"Pineda","year":"2009","journal-title":"Semin Plast Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e3280","DOI":"10.1002\/dmrr.3280","article-title":"Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Lipsky","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1002\/9781119720676.ch21","article-title":"Diabetic Foot Osteomyelitis","author":"Senneville","year":"2021","journal-title":"Bone and Joint Infections"},{"key":"B10","doi-asserted-by":"publisher","first-page":"702","DOI":"10.3332\/ecancer.2016.702","article-title":"The neutrophil-to-lymphocyte ratio: a narrative review","volume":"10","author":"Socorro Faria","year":"2016","journal-title":"Ecancermedicalscience"},{"key":"B11","doi-asserted-by":"publisher","first-page":"dju124","DOI":"10.1093\/jnci\/dju124","article-title":"Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis","volume":"106","author":"Templeton","year":"2014","journal-title":"J Natl Cancer Inst"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6212","DOI":"10.1158\/1078-0432.CCR-14-0442","article-title":"Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma","volume":"20","author":"Hu","year":"2014","journal-title":"Clin Cancer Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"51","DOI":"10.3390\/diseases11010051","article-title":"Neutrophil-to-lymphocyte ratio as a predictor of postoperative outcomes in traumatic brain injury: a systematic review and meta-analysis","volume":"11","author":"Nguyen","year":"2023","journal-title":"Diseases"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e59321","DOI":"10.1371\/journal.pone.0059321","article-title":"C-reactive protein\/albumin ratio predicts 90-day mortality of septic patients","volume":"8","author":"Ranzani","year":"2013","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"30","DOI":"10.7861\/clinmedicine.9-1-30","article-title":"Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein\/albumin ratio as a predictor of patient outcome","volume":"9","author":"Fairclough","year":"2009","journal-title":"Clin Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1186\/s12877-022-03339-2","article-title":"Prognostic value of ambulation ability with albumin and C-reactive protein to predict 28-day mortality in elderly sepsis patients","volume":"22","author":"Cha","year":"2022","journal-title":"BMC Geriatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"7453354","DOI":"10.1155\/2022\/7453354","article-title":"Diagnostic value of systemic inflammatory response index for catheter-related bloodstream infection in patients undergoing haemodialysis","volume":"2022","author":"Yang","year":"2022","journal-title":"J Immunol Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1186\/s12879-026-13730-8","article-title":"The role of CAR and SII values in determining mortality in COVID-19 patients: a retrospective observational study","volume":"26","author":"\u00d6zbay","year":"2026","journal-title":"BMC Infect Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1148786","DOI":"10.3389\/fonc.2023.1148786","article-title":"Prognostic role of C-reactive protein-to-albumin ratio in cancer patients treated with immune checkpoint inhibitors: a meta-analysis","volume":"13","author":"Dai","year":"2023","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.3390\/diagnostics15172230","article-title":"C-reactive protein-to-albumin ratio and prognostic nutrition index as predictors of periprosthetic joint infection and early postoperative wound complications","volume":"15","author":"Karlidag","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.cpm.2025.12.007","article-title":"Biomarkers in diabetic foot","volume":"43","author":"Lee","year":"2026","journal-title":"Clin Podiatr Med Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"342","DOI":"10.13107\/JOCR.2025.V15.I09.6120","article-title":"Role of biomarkers in diabetic foot osteomyelitis","volume":"15","author":"Gureh","year":"2025","journal-title":"J Orthop Case Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1186\/s12879-018-3550-6","article-title":"Factors predictive of relapse in adult bacterial osteomyelitis of long bones","volume":"18","author":"Garcia Del Pozo","year":"2018","journal-title":"BMC Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1302\/0301-620X.95B11.33135","article-title":"Proceedings of the international consensus on periprosthetic joint infection","author":"Parvizi","year":"2013","journal-title":"Bone Joint J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1038\/s41579-022-00686-0","article-title":"Skeletal infections: microbial pathogenesis, immunity and clinical management","volume":"20","author":"Masters","year":"2022","journal-title":"Nat Rev Microbiol"},{"key":"B26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/978-1-4419-6084-9_5","article-title":"Implant-associated infection","volume-title":"Biofilm Infections","author":"Zimmerli","year":"2011"},{"key":"B27","doi-asserted-by":"publisher","first-page":"505","DOI":"10.14744\/nci.2022.04935","article-title":"Rifaximine spacer application is not superior to local teicoplanin treatment in a rat model of osteomyelitis","volume":"9","author":"Yucel","year":"2022","journal-title":"Northern Clinics of Istanbul"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1953342\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:24:03Z","timestamp":1788755043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1953342\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":27,"alternative-id":["10.3389\/fmed.2026.1953342"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1953342","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]},"article-number":"1953342"}}