Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America.
PLoS One. 2010 Feb 22;5(2):e9358. doi: 10.1371/journal.pone.0009358.
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have been shown to be useful for diagnosis of prosthetic hip and knee infection. Little information is available on CRP and ESR in patients undergoing revision or resection of shoulder arthroplasties or spine implants.
METHODS/RESULTS: We analyzed preoperative CRP and ESR in 636 subjects who underwent knee (n=297), hip (n=221) or shoulder (n=64) arthroplasty, or spine implant (n=54) removal. A standardized definition of orthopedic implant-associated infection was applied. Receiver operating curve analysis was used to determine ideal cutoff values for differentiating infected from non-infected cases. ESR was significantly different in subjects with aseptic failure infection of knee (median 11 and 53.5 mm/h, respectively, p=<0.0001) and hip (median 11 and 30 mm/h, respectively, p=<0.0001) arthroplasties and spine implants (median 10 and 48.5 mm/h, respectively, p=0.0033), but not shoulder arthroplasties (median 10 and 9 mm/h, respectively, p=0.9883). Optimized ESR cutoffs for knee, hip and shoulder arthroplasties and spine implants were 19, 13, 26, and 45 mm/h, respectively. Using these cutoffs, sensitivity and specificity to detect infection were 89 and 74% for knee, 82 and 60% for hip, and 32 and 93% for shoulder arthroplasties, and 57 and 90% for spine implants. CRP was significantly different in subjects with aseptic failure and infection of knee (median 4 and 51 mg/l, respectively, p<0.0001), hip (median 3 and 18 mg/l, respectively, p<0.0001), and shoulder (median 3 and 10 mg/l, respectively, p=0.01) arthroplasties, and spine implants (median 3 and 20 mg/l, respectively, p=0.0011). Optimized CRP cutoffs for knee, hip, and shoulder arthroplasties, and spine implants were 14.5, 10.3, 7, and 4.6 mg/l, respectively. Using these cutoffs, sensitivity and specificity to detect infection were 79 and 88% for knee, 74 and 79% for hip, and 63 and 73% for shoulder arthroplasties, and 79 and 68% for spine implants.
CRP and ESR have poor sensitivity for the diagnosis of shoulder implant infection. A CRP of 4.6 mg/l had a sensitivity of 79 and a specificity of 68% to detect infection of spine implants.
C-反应蛋白（CRP）和红细胞沉降率（ESR）已被证明可用于诊断人工髋关节和膝关节感染。关于接受肩部关节置换或脊柱植入物翻修或切除的患者的 CRP 和 ESR 信息很少。
方法/结果：我们分析了 636 名接受膝关节（n=297）、髋关节（n=221）或肩部（n=64）关节置换术或脊柱植入物（n=54）取出的患者的术前 CRP 和 ESR。应用了一种标准化的骨科植入物相关感染定义。接收器工作曲线分析用于确定区分感染与非感染病例的理想截断值。ESR 在膝关节（中位数分别为 11 和 53.5mm/h，p<0.0001）和髋关节（中位数分别为 11 和 30mm/h，p<0.0001）以及脊柱植入物（中位数分别为 10 和 48.5mm/h，p=0.0033）的无菌性失败感染患者中差异显著，但在肩部关节置换患者中差异不显著（中位数分别为 10 和 9mm/h，p=0.9883）。膝关节、髋关节和肩部关节置换术以及脊柱植入物的优化 ESR 截断值分别为 19、13、26 和 45mm/h。使用这些截断值，检测感染的敏感性和特异性分别为膝关节的 89%和 74%、髋关节的 82%和 60%、肩部关节置换术的 32%和 93%以及脊柱植入物的 57%和 90%。CRP 在膝关节（中位数分别为 4 和 51mg/l，p<0.0001）、髋关节（中位数分别为 3 和 18mg/l，p<0.0001）、肩部（中位数分别为 3 和 10mg/l，p=0.01）关节置换术和脊柱植入物（中位数分别为 3 和 20mg/l，p=0.0011）无菌性失败和感染患者中差异显著。膝关节、髋关节、肩部关节置换术和脊柱植入物的优化 CRP 截断值分别为 14.5、10.3、7 和 4.6mg/l。使用这些截断值，检测感染的敏感性和特异性分别为膝关节的 79%和 88%、髋关节的 74%和 79%、肩部关节置换术的 63%和 73%以及脊柱植入物的 79%和 68%。
CRP 和 ESR 对肩部植入物感染的诊断敏感性较差。CRP 为 4.6mg/l 时，检测脊柱植入物感染的敏感性为 79%，特异性为 68%。
