The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Orthop Surg. 2021 May;13(3):708-718. doi: 10.1111/os.12966. Epub 2021 Mar 14.
There is a controversy on the diagnostic reliability and accuracy of synovial fluid α-defensin in periprosthetic joint infection (PJI). We performed this meta-analysis to evaluate the diagnostic accuracy of the α-defensin lateral flow test in PJI.
PubMed, Embase, and the Cochrane library were systematically searched, and articles (up to January 2020) on the diagnosis of hip and knee PJIs using the α-defensin Synovasure lateral flow test were included. The diagnostic accuracy of the α-defensin lateral flow test in PJI was evaluated using meta-analysis. The pooled sensitivity, specificity, accuracy, positive and negative likelihood ratio, diagnostic odds ratio, and post-test probabilities were calculated.
Seventeen studies including 1443 cases were included. Meta-analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and a diagnostic odds ratio was 0.83 (95% CI 0.77, 0.88), 0.95 (95% CI 0.93, 0.97), 16.86 (95% CI 11.67, 24.37), 0.17 (95% CI 0.13, 0.24) and 85.30 (95% CI 47.76, 152.35), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97 (95% CI 0.95, 0.98). Subgroup analysis also confirmed the high efficiency of α-defensin Synovasure lateral flow test in diagnosing PJIs, irrespective of ethnicity. Fagan's nomogram analysis there was a high positive post-test probability of 94% and a low negative post-test probability of 15%.
We indicated that the α-defensin lateral flow test had a high accuracy for diagnosing PJI. Large-scale studies are needed to validate its significance in PJI diagnosis.
关节置换术后感染（PJI）中滑膜α-防御素的诊断可靠性和准确性存在争议。我们进行了这项荟萃分析，以评估α-防御素侧向流动试验在 PJI 中的诊断准确性。
系统检索了 PubMed、Embase 和 Cochrane 图书馆，并纳入了使用α-防御素 Synovasure 侧向流动试验诊断髋关节和膝关节 PJI 的文章（截至 2020 年 1 月）。使用荟萃分析评估α-防御素侧向流动试验在 PJI 中的诊断准确性。计算了α-防御素侧向流动试验的汇总敏感性、特异性、准确性、阳性似然比、阴性似然比、诊断比值比和后测概率。
纳入了 17 项研究，共 1443 例患者。荟萃分析显示，汇总敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为 0.83（95%CI 0.77，0.88）、0.95（95%CI 0.93，0.97）、16.86（95%CI 11.67，24.37）、0.17（95%CI 0.13，0.24）和 85.30（95%CI 47.76，152.35）。分层汇总受试者工作特征曲线下面积为 0.97（95%CI 0.95，0.98）。亚组分析也证实了α-防御素 Synovasure 侧向流动试验在诊断 PJI 方面的高效率，不论种族如何。Fagan 列线图分析表明，阳性后测概率高，为 94%，阴性后测概率低，为 15%。
我们表明，α-防御素侧向流动试验对诊断 PJI 具有较高的准确性。需要进行大规模研究来验证其在 PJI 诊断中的意义。
