Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition.

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2023-01-01 DOI:10.5194/jbji-8-109-2023
Sara Elisa Diniz, Ana Ribau, André Vinha, José Carlos Oliveira, Miguel Araújo Abreu, Ricardo Sousa
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引用次数: 2

Abstract

Introduction: diagnosis of periprosthetic joint infection (PJI) is challenging, as no single test has absolute accuracy. The purpose of this study was to assess the utility of different simple synovial biomarkers in the diagnosis of PJI as defined by the European Bone and Joint Infection Society (EBJIS). Methods: we retrospectively identified all patients undergoing revision hip or knee arthroplasty from 2013 to 2019 on our prospectively maintained database. Only patients with minimum required infection diagnostic workup were included in the study. Patients with comorbidities that may influence the accuracy of synovial biomarkers were excluded. Receiver operator characteristic (ROC) curves were utilised to assess the diagnostic utility of synovial fluid white blood cell (WBC) count, polymorphonuclear leukocyte percentage (PMN %), C-reactive protein (CRP), adenosine deaminase (ADA), and alpha-2-microglobulin (A2M). Results: in total, 102 patients met the inclusion criteria. Of these, 58 were classified as infection unlikely, 8 as infection likely, and 36 as infection confirmed. Synovial WBC count (area under the curve (AUC) 0.94) demonstrated the best utility for the diagnosis of PJI, followed by PMN % (AUC 0.91), synovial CRP (AUC 0.90), ADA (AUC 0.82), and A2M (AUC 0.76). We found added value in the combined interpretation of different biomarkers. We calculated high sensitivity and negative predictive value if at least two of them are negative and high specificity and positive predictive value if at least two are elevated. Conclusion: current results show that synovial fluid investigation is a useful tool for the diagnosis of PJI, and the combined interpretation of simple and inexpensive biomarkers demonstrated improved diagnostic accuracy.

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根据新的EBJIS定义,用于诊断假体关节感染的简单且廉价的滑液生物标志物。
导言:诊断假体周围关节感染(PJI)是具有挑战性的,因为没有单一的测试具有绝对的准确性。本研究的目的是评估欧洲骨关节感染学会(EBJIS)定义的不同简单滑膜生物标志物在PJI诊断中的效用。方法:我们在前瞻性维护的数据库中回顾性地确定了2013年至2019年所有接受髋关节或膝关节置换术翻修的患者。只有最低要求的感染诊断检查的患者被纳入研究。排除了可能影响滑膜生物标志物准确性的合并症患者。采用受试者操作特征(ROC)曲线评估滑液白细胞(WBC)计数、多形核白细胞百分比(PMN %)、c反应蛋白(CRP)、腺苷脱氨酶(ADA)和α -2微球蛋白(A2M)的诊断价值。结果:102例患者符合纳入标准。其中58例为不太可能感染,8例为可能感染,36例为确诊感染。滑膜WBC计数(曲线下面积(AUC) 0.94)对PJI的诊断最有用,其次是PMN % (AUC 0.91)、滑膜CRP (AUC 0.90)、ADA (AUC 0.82)和A2M (AUC 0.76)。我们发现不同生物标记物的综合解释具有附加价值。如果其中至少两项为阴性,则计算高敏感性和阴性预测值;如果至少两项升高,则计算高特异性和阳性预测值。结论:目前的研究结果表明,滑液检查是诊断PJI的一种有用工具,简单和廉价的生物标志物的联合解释提高了诊断的准确性。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
29
审稿时长
12 weeks
期刊最新文献
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