Shahi Alisina, Tan Timothy L, Kheir Michael M, Tan Dean D, Parvizi Javad
The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2017 Sep;32(9S):S232-S235. doi: 10.1016/j.arth.2017.06.005. Epub 2017 Jun 10.
Diagnosis of periprosthetic joint infection (PJI) remains a challenge despite a wide variety of available diagnostic tests. The question that arises is which of these tests has a better performance for diagnosing PJI. Diagnostic odds ratio (DOR) has been described as the best indicator for test performance.
To compare the performance of the standard diagnostic tests, the DOR of serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), synovial fluid (SF) white blood cell (WBC) count, SF polymorphonuclear (PMN%), and leukocyte esterase (LE) were calculated.
We obtained 4662 ESRs, 4392 CRPs, 836 SF WBC, 804 SF PMN%, and 659 LE results. LE had the highest DOR for diagnosing PJI: 30.06 (95% confidence interval [CI]: 17.8-50.7). The rest of the DORs in the descending order were SF WBC: 29.4 (95% CI: 20.2-42.8), CRP: 25.6 (95% CI: 19.5-33.7), SF PMN%: 25.5 (95% CI: 17.5-37.0), and ESR: 14.6 (95% CI: 11.5-18.6).
Based on our findings, it appears that among the minor diagnostic criteria, LE has the best performance.
尽管有各种各样可用的诊断测试，但人工关节周围感染（PJI）的诊断仍然是一个挑战。出现的问题是这些测试中哪一种在诊断PJI方面表现更好。诊断比值比（DOR）已被描述为测试性能的最佳指标。
为了比较标准诊断测试的性能，计算了血清红细胞沉降率（ESR）和C反应蛋白（CRP）、滑液（SF）白细胞（WBC）计数、SF多形核细胞（PMN%）和白细胞酯酶（LE）的DOR。
我们获得了4662份ESR、4392份CRP、836份SF WBC、804份SF PMN%和659份LE结果。LE在诊断PJI方面的DOR最高：30.06（95%置信区间[CI]：17.8 - 50.7）。其余DOR按降序排列为：SF WBC：29.4（95% CI：20.2 - 42.8），CRP：25.6（95% CI：19.5 - 33.7），SF PMN%：25.5（95% CI：17.5 - 37.0），以及ESR：14.6（95% CI：11.5 - 18.6）。
根据我们的研究结果，在次要诊断标准中，LE似乎表现最佳。
