Department of Microbiology, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Road, Winchester, SO22 5DG, UK.
Infection. 2013 Aug;41(4):845-9. doi: 10.1007/s15010-013-0467-2. Epub 2013 May 4.
Differentiating septic arthritis from non-septic arthritis can be challenging as the clinical pictures are similar and an efficacious diagnostic test is not yet available. Our objectives in this study were to establish if procalcitonin (PCT) could be reproducibly measured from synovial fluid, if there is a difference in synovial procalcitonin values between patients with septic and non-septic arthritis, respectively, including those with implants and to determine cut-off levels that could be used as a practical tool in the management of these conditions.
Using a standard serum assay, synovial fluid PCT levels were measured retrospectively in 26 septic and 50 non-septic predefined arthritis cases. The reproducibility of synovial PCT was also assessed at various concentrations.
Synovial PCT can be measured and is reproducible. In this cohort, statistically significant higher synovial PCT levels were found in cases of septic arthritis than in non-septic arthritis. Sensitivities, specificities and positive and negative predictive values varied at different cut-off levels.
The test could be added to other microbiological and biochemical tests and may be used to supplement other clinical, radiological and laboratory findings in the assessment of patients with acute painful joints. In our cohort, findings of very high synovial PCT levels supported an infection process, including in prosthesis-related infections. The high negative predictive value of low synovial PCT levels could exclude infection in both native and prosthetic joints. Larger prospective studies are needed to further validate these results and to examine the cost effectiveness of synovial PCT.
由于临床症状相似，且目前尚无有效的诊断性检测方法，因此区分细菌性关节炎和非细菌性关节炎具有一定挑战性。本研究旨在确定关节滑液中能否重复检测降钙素原（PCT），细菌性和非细菌性关节炎患者（包括带植入物的患者）的关节滑液 PCT 值是否存在差异，并确定可用于这些疾病管理的实用工具的临界值。
使用标准血清检测方法，回顾性检测了 26 例细菌性关节炎和 50 例非细菌性关节炎患者的关节滑液 PCT 水平。还评估了不同浓度下关节滑液 PCT 的重复性。
关节滑液 PCT 可检测且具有可重复性。在本队列中，细菌性关节炎患者的关节滑液 PCT 水平显著高于非细菌性关节炎患者。不同临界值下的敏感性、特异性、阳性预测值和阴性预测值不同。
该检测方法可与其他微生物学和生化检测方法联合使用，可用于辅助评估急性关节痛患者的其他临床、影像学和实验室检查结果。在本队列中，关节滑液 PCT 水平非常高提示感染过程，包括假体相关感染。关节滑液 PCT 水平较低的阴性预测值较高，可排除原发性和假体关节的感染。需要进一步开展前瞻性研究来验证这些结果，并评估关节滑液 PCT 的成本效益。
