Department of Clinical Microbiology, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Department of Microbiology, Institute for Global Health (ISGlobal), Barcelona, Spain.
Department of Clinical Microbiology, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
J Arthroplasty. 2019 Jan;34(1):123-125. doi: 10.1016/j.arth.2018.09.047. Epub 2018 Sep 22.
Periprosthetic joint infection (PJI) remains a major clinical challenge. In this study, we evaluated the diagnostic performance of lipocalin-2 (LCN2), a well-characterized neutrophil protein, in synovial fluid to discriminate PJI and aseptic implant failure.
Synovial fluid from patients with acute or chronic PJI, aseptic failure, or controls was obtained during surgery. LCN2 was quantified using a modified enzyme immunoassay coupled with chemiluminescence (Architect Urine NGAL; Abbott Laboratories).
Synovial fluid was collected from 72 patients: 22 (30.6%) proven infections, 22 (30.6%) aseptic implant failures, and 28 (38.8%) controls. Synovial fluid was obtained from the hip in 18 (25%) and knee in 54 (75%) cases. Among infections, there were 16 (22.2%) acute and 6 (8.3%) chronic PJIs. The median (interquartile range) LCN2 concentration in synovial fluid was 1536.5 ng/mL (261.8-12,923) in the infection group, 87.0 (54.8-135) in the aseptic group, and 55 (45-67.8) in the control group (P < .001). LCN2 discriminated nearly perfectly between controls and confirmed infection (area under the receiver operating characteristic 0.98, 95% confidence interval 0.95-1.00). The optimal cut-off value for maximal sensitivity (86.3%) and specificity (77.2%) to discriminate aseptic failure versus proven infection was 152 ng/mL, with an area under the receiver operating characteristic of 0.92 (95% confidence interval 0.84-0.99).
LCN2 is a potential novel biomarker that may be helpful to inform surgical teams on the potential risk of PJI and optimize specific surgical interventions as it distinguishes between septic and aseptic failure of prosthesis with high sensitivity and specificity.
假体周围关节感染（PJI）仍然是一个主要的临床挑战。在这项研究中，我们评估了中性粒细胞蛋白脂联素-2（LCN2）在滑液中的诊断性能，以区分 PJI 和无菌性植入物失败。
在手术过程中从患有急性或慢性 PJI、无菌性失败或对照的患者中获得滑膜液。使用改良的酶免疫测定法（Architect Urine NGAL；雅培实验室）结合化学发光来定量 LCN2。
共收集了 72 名患者的滑膜液：22 名（30.6%）确诊感染，22 名（30.6%）无菌性植入物失败，28 名（38.8%）为对照。滑膜液取自 18 例（25%）髋关节和 54 例（75%）膝关节。在感染中，有 16 例（22.2%）急性和 6 例（8.3%）慢性 PJI。感染组滑膜液中 LCN2 的中位数（四分位距）为 1536.5ng/ml（261.8-12923），无菌组为 87.0ng/ml（54.8-135），对照组为 55ng/ml（45-67.8）（P<.001）。LCN2 几乎完美地区分了对照组和确诊感染（受试者工作特征曲线下面积 0.98，95%置信区间 0.95-1.00）。区分无菌性失败与确诊感染的最大敏感性（86.3%）和特异性（77.2%）的最佳截断值为 152ng/ml，受试者工作特征曲线下面积为 0.92（95%置信区间 0.84-0.99）。
LCN2 是一种潜在的新型生物标志物，可帮助手术团队了解 PJI 的潜在风险，并优化特定的手术干预措施，因为它具有高灵敏度和特异性，可区分假体的感染性和无菌性失败。
