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Peer-reviewedCC BYActa orthopaedica

Plasma calprotectin as infection biomarker in hip fracture patients: a prospective cohort study.

  • Helmi-Sisko Pyrhönen1
  • Johan Tham2
  • Anna Stefánsdóttir3
  • Alicia Persson4
  • Linnea Malmgren5
  • Cecilia Rogmark6
6 affiliations
  1. 1Department of Orthopedics, Skåne University Hospital, Malmö; 2 Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. [email protected].
  2. 2Department of Infectious Diseases, Skåne University Hospital, Malmö; Department of Translational Medicine, Lund University, Malmö, Sweden.
  3. 3Department of Orthopedics, Skåne University Hospital, Lund; Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden.
  4. 4Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.
  5. 5Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö; Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.
  6. 6Department of Orthopedics, Skåne University Hospital, Malmö; Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.
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Abstract

Background and purpose

We aimed to compare the diagnostic performance of plasma calprotectin in detecting infections following hip fracture surgery with 3 other biomarkers: procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count.Methods

This prospective cohort study included surgically treated hip fracture patients aged ≥ 65 years, admitted to our department from April 2023 to August 2024. Plasma calprotectin, PCT, CRP, and WBC count were measured on postoperative day 3. The outcome was any infection within 30 days (primary) and 7 days (secondary). Biomarker performance was evaluated using receiver operating characteristic analyses in a comparative framework.Results

166/550 individuals were analyzed (median age 85 years, 68% women). 19% (n = 31) and 12% (n = 20) had infection within 30 and respectively 7 days. For 30-day infections, calprotectin showed highest area under the curve (AUC) of 0.66 (95% confidence interval [CI] 0.54-0.77), followed by WBC count 0.60 (CCI 0.48-0.72), CRP 0.53 (CI 0.42-0.63), and PCT 0.51 (CI 0.40-0.63). Difference in AUC was largest between calprotectin and PCT (0.14, CI 0.00-0.29), followed by CRP (0.12, CI -0.01 to 0.26), while similar to WBC count (0.06, CI -0.05 to 0.16). For 7-day infections, AUCs were as following: calprotectin 0.70 (CI 0.58-0.82), WBC count 0.69 (CI 0.56-0.81), CRP 0.56 (CI 0.42-0.69), and PCT 0.48 (CI 0.33-0.63). Difference in AUC was largest between calprotectin and PCT (0.22, CI 0.05-0.39), followed by CRP (0.15, CI -0.02 to 0.31), while WBC count was similar (0.01, CI -0.09 to 0.12).Conclusion

Calprotectin demonstrated a trend towards superior discriminatory ability for infections compared with PCT and CRP, particularly for infections within 7 days. Calprotectin provided moderate diagnostic accuracy, likewise WBC count.

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Cite

BibTeXRIS
BibTeX
@article{pyrhonen2026plasma,
  title = {{Plasma calprotectin as infection biomarker in hip fracture patients: a prospective cohort study.}},
  author = {Helmi-Sisko Pyrhönen and Johan Tham and Anna Stefánsdóttir and Alicia Persson and Linnea Malmgren and Cecilia Rogmark},
  journal = {Acta orthopaedica},
  year = {2026},
  month = oct,
  doi = {10.2340/17453674.2026.46719},
  url = {https://europepmc.org/article/MED/42894498},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Plasma calprotectin as infection biomarker in hip fracture patients: a prospective cohort study.
AU  - Helmi-Sisko Pyrhönen
AU  - Johan Tham
AU  - Anna Stefánsdóttir
AU  - Alicia Persson
AU  - Linnea Malmgren
AU  - Cecilia Rogmark
PY  - 2026
DA  - 2026/10/19
JO  - Acta orthopaedica
DO  - 10.2340/17453674.2026.46719
UR  - https://europepmc.org/article/MED/42894498
AB  - Background and purpose  We aimed to compare the diagnostic performance of plasma calprotectin in detecting infections following hip fracture surgery with 3 other biomarkers: procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count.Methods  This prospective cohort study included surgically treated hip fracture patients aged ≥ 65 years, admitted to our department from April 2023 to August 2024. Plasma calprotectin, PCT, CRP, and WBC count were measured on postoperative day 3. The outcome was any infection within 30 days (primary) and 7 days (secondary). Biomarker performance was evaluated using receiver operating characteristic analyses in a comparative framework.Results  166/550 individuals were analyzed (median age 85 years, 68% women). 19% (n = 31) and 12% (n = 20) had infection within 30 and respectively 7 days. For 30-day infections, calprotectin showed highest area under the curve (AUC) of 0.66 (95% confidence interval [CI] 0.54-0.77), followed by WBC count 0.60 (CCI 0.48-0.72), CRP 0.53 (CI 0.42-0.63), and PCT 0.51 (CI 0.40-0.63). Difference in AUC was largest between calprotectin and PCT (0.14, CI 0.00-0.29), followed by CRP (0.12, CI -0.01 to 0.26), while similar to WBC count (0.06, CI -0.05 to 0.16). For 7-day infections, AUCs were as following: calprotectin 0.70 (CI 0.58-0.82), WBC count 0.69 (CI 0.56-0.81), CRP 0.56 (CI 0.42-0.69), and PCT 0.48 (CI 0.33-0.63). Difference in AUC was largest between calprotectin and PCT (0.22, CI 0.05-0.39), followed by CRP (0.15, CI -0.02 to 0.31), while WBC count was similar (0.01, CI -0.09 to 0.12).Conclusion  Calprotectin demonstrated a trend towards superior discriminatory ability for infections compared with PCT and CRP, particularly for infections within 7 days. Calprotectin provided moderate diagnostic accuracy, likewise WBC count.
SN  - 1745-3674
SN  - 1745-3682
ER  -