Yoon Jung-Ro, Yang Se-Hyun, Shin Young-Soo
Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea.
Int Orthop. 2018 Jun;42(6):1213-1226. doi: 10.1007/s00264-017-3744-3. Epub 2018 Jan 2.
Many studies have found associations between laboratory biomarkers and periprosthetic joint infection (PJI), but it remains unclear whether these biomarkers are clinically useful in ruling out PJI. This meta-analysis compared the performance of interleukin-6 (IL-6) versus procalcitonin (PCT) for the diagnosis of PJI.
In this meta-analysis, we reviewed studies that evaluated IL-6 or/and PCT as a diagnostic biomarker for PJI and provided sufficient data to permit sensitivity and specificity analyses for each test. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through February 28, 2017. No restrictions were placed on language of publication.
We identified 18 studies encompassing a total of 1,835 subjects; 16 studies reported on IL-6 and 6 studies reported on PCT. The area under the curve (AUC) was 0.93 (95% CI, 0.91-0.95) for IL-6 and 0.83 (95% CI, 0.79-0.86) for PCT. The pooled sensitivity was 0.83 (95% CI, 0.74-0.89) for IL-6 and 0.58 (95% CI, 0.31-0.81) for PCT. The pooled specificity was 0.91 (95% CI, 0.84-0.95) for IL-6 and 0.95 (95% CI, 0.63-1.00) for PCT. Both the IL-6 and PCT tests had a high positive likelihood ratio (LR); 9.3 (95% CI, 5.3-16.2) and 12.4 (95% CI, 1.7-89.8), respectively, making them excellent rule-in tests for the diagnosis of PJI. The pooled negative LR for IL-6 was 0.19 (95% CI, 0.12-0.29), making it suitable as a rule-out test, whereas the pooled negative LR for PCT was 0.44 (95% CI, 0.25-0.78), making it unsuitable as a rule-out diagnostic tool.
Based on the results of the present meta-analysis, IL-6 has higher diagnostic value than PCT for the diagnosis of PJI. Moreover, the specificity of the IL-6 test is higher than its sensitivity. Conversely, PCT is not recommended for use as a rule-out diagnostic tool.
许多研究已发现实验室生物标志物与假体周围关节感染（PJI）之间存在关联，但这些生物标志物在排除PJI方面是否具有临床实用性仍不明确。本荟萃分析比较了白细胞介素-6（IL-6）与降钙素原（PCT）在诊断PJI方面的性能。
在本荟萃分析中，我们回顾了评估IL-6或/和PCT作为PJI诊断生物标志物的研究，并提供了足够的数据以对每项检测进行敏感性和特异性分析。检索了主要数据库MEDLINE、EMBASE、Cochrane图书馆、科学引文索引和SCOPUS，以查找从最早可检索日期至2017年2月28日的相关研究。对发表语言不设限制。
我们确定了18项研究，共纳入1835名受试者；16项研究报告了IL-6，6项研究报告了PCT。IL-6的曲线下面积（AUC）为0.93（95%可信区间，0.91 - 0.95），PCT的AUC为0.83（95%可信区间，0.79 - 0.86）。IL-6的合并敏感性为0.83（95%可信区间，0.74 - 0.89），PCT的合并敏感性为0.58（95%可信区间，0.31 - 0.81）。IL-6的合并特异性为0.91（95%可信区间，0.84 - 0.95），PCT的合并特异性为0.95（95%可信区间，0.63 - 1.00）。IL-6和PCT检测均具有较高的阳性似然比（LR）；分别为9.3（95%可信区间，5.3 - 16.2）和12.4（95%可信区间，1.7 - 89.8），使其成为诊断PJI的优秀诊断试验。IL-6的合并阴性似然比为0.19（95%可信区间，0.12 - 0.29），适合作为排除试验，而PCT的合并阴性似然比为0.44（95%可信区间，0.25 - 0.78），不适合作为排除诊断工具。
基于本荟萃分析的结果，IL-6在诊断PJI方面比PCT具有更高的诊断价值。此外，IL-6检测的特异性高于其敏感性。相反，不建议将PCT用作排除诊断工具。
