Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Biomed Res Int. 2018 Oct 1;2018:8351308. doi: 10.1155/2018/8351308. eCollection 2018.
Periprosthetic joint infection (PJI) remains challenging since a "gold standard" for diagnosis has not yet been established. This study aimed to evaluate the accuracy of synovial fluid procalcitonin (SF-PCT) and serum procalcitonin as a diagnostic biomarker for PJI and to compare its accuracy against standard methods.
A prospective cohort study was conducted during 2015-2017 in 32 patients with painful hip or knee arthroplasty who have underwent revision surgery. Relevant clinical and laboratory data were collected. PJI was diagnosed based on the 2013 international consensus criteria. Preoperative blood sample and intraoperatively acquired joint fluid were taken for PCT measurement with a standard assay. Diagnostic accuracy was analyzed by the receiver-operating characteristic curve and the area under the curve (AUC).
Twenty patients (62.5%) were classified as the PJI group, and 12 (37.5%) were classified as the aseptic loosening group. The median age was 68 years (range 38-87 years). The median values of SF-PCT and serum PCT in the PJI group were both significantly higher than those in the aseptic loosening group: the median serum PCT levels (interquartile range: IQR) were 0.33 ng/mL (0.08-2.79 ng/mL) in the PJI group compared with 0.04 ng/mL (0.03-0.06 ng/mL), and the median SF-PCT levels (IQR) were 0.16 ng/mL (0.12-0.26 ng/mL) in PJI group compared with 0.00 (0.00-0.00 ng/mL) ( < 0.001, both). SF-PCT, with a cut-off level of 0.08 ng/mL, had an AUC of 0.87, a sensitivity of 90.0%, a specificity of 83.3%, and a negative likelihood ratio (LR-) of 0.12. Serum PCT, with a standard cut-off level of 0.5 ng/mL, had an AUC of 0.70, a sensitivity of 40.0%, a specificity of 100.0%, and a LR- of 0.60.
SF-PCT appears to be a reliable test and could be useful as an alternative indicator or in combination with standard methods for diagnosing PJI.
尽管尚未确立诊断假体周围关节感染（PJI）的“金标准”，但该疾病仍然极具挑战性。本研究旨在评估关节滑液降钙素原（SF-PCT）和血清降钙素原作为 PJI 诊断生物标志物的准确性，并将其与标准方法进行比较。
这是一项于 2015 年至 2017 年期间开展的前瞻性队列研究，共纳入 32 例因髋关节或膝关节置换术后疼痛而接受翻修手术的患者。收集了相关的临床和实验室数据。根据 2013 年国际共识标准诊断 PJI。使用标准测定法测量术前血样和术中采集的关节液中的 PCT 值。通过受试者工作特征曲线和曲线下面积（AUC）分析诊断准确性。
20 例（62.5%）患者被归类为 PJI 组，12 例（37.5%）患者被归类为无菌性松动组。患者的中位年龄为 68 岁（范围 38-87 岁）。PJI 组 SF-PCT 和血清 PCT 的中位数均显著高于无菌性松动组：PJI 组血清 PCT 水平（中位数[四分位距]）为 0.33ng/ml（0.08-2.79ng/ml），而无菌性松动组为 0.04ng/ml（0.03-0.06ng/ml）（<0.001），PJI 组 SF-PCT 水平（中位数[四分位距]）为 0.16ng/ml（0.12-0.26ng/ml），而无菌性松动组为 0.00（0.00-0.00ng/ml）（<0.001）。SF-PCT 的截断值为 0.08ng/ml，AUC 为 0.87，灵敏度为 90.0%，特异性为 83.3%，阴性似然比（LR-）为 0.12。血清 PCT 的标准截断值为 0.5ng/ml，AUC 为 0.70，灵敏度为 40.0%，特异性为 100.0%，LR-为 0.60。
SF-PCT 似乎是一种可靠的检测方法，可作为诊断 PJI 的替代指标或与标准方法联合使用。
