title: Elevations in D-dimer and C-reactive protein are associated with the development of osteonecrosis of the hip in HIV-infected adults.
abstract: BACKGROUND
  A high incidence of nontraumatic osteonecrosis has been reported in HIV-infected patients. We investigated the levels of D-dimer and C-reactive protein (CRP) in a cohort of HIV-infected adults with and without osteonecrosis of the femoral head.
  
  
  METHODS
  Forty-three HIV-infected patients with osteonecrosis of the femoral head and a comparison group of 50 HIV-infected patients with negative MRI of the hips and for whom serial plasma samples were available were included. D-dimer and CRP levels were measured prior to and at the time of diagnosis for osteonecrosis patients, at the time of negative MRI of the hips for controls, and at least 6 months later for both groups.
  
  
  RESULTS
  Biomarker levels were elevated at the time of diagnosis in the osteonecrosis cohort compared with controls. Median D-dimer value was 0.32 μg/ml in the osteonecrosis group compared with less than 0.22 μg/ml in the control group (P = 0.016). For CRP, the corresponding values were 2.52 mg/l and 1.23 mg/l (P = 0.003). Postdiagnosis, D-dimer and CRP levels were also elevated in the osteonecrosis patients compared with controls. Linear regression demonstrated a rise in D-dimer levels from prediagnosis to diagnosis in the osteonecrosis patients whereas CRP levels did not change significantly over time.
  
  
  CONCLUSIONS
  Compared to controls, patients who developed osteonecrosis had elevated levels of D-dimer and CRP at diagnosis. D-dimer levels increased whereas CRP levels did not change significantly from prediagnosis to diagnosis. These data suggest that patients with higher levels of inflammation are at an increased risk of osteonecrosis.
authors.affiliation: Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA. cmorse@mail.nih.gov
authors.forename: Caryn G
authors.initials: CG
authors.lastname: Morse
authors.forename: Lori E
authors.initials: LE
authors.lastname: Dodd
authors.forename: Khanh
authors.initials: K
authors.lastname: Nghiem
authors.forename: Rene
authors.initials: R
authors.lastname: Costello
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Csako
authors.forename: H Clifford
authors.initials: HC
authors.lastname: Lane
authors.forename: Jay N
authors.initials: JN
authors.lastname: Lozier
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kovacs
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D018791:CD4 Lymphocyte Count; D005260:Female; D005271:Femur Head Necrosis / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006679:HIV Seropositivity / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000276:immunology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein