Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.
College of Medicine and Public Health, Flinders University College of Medicine and Public Health, Bedford Park, Australia.
Bone Joint J. 2022 Mar;104-B(3):311-320. doi: 10.1302/0301-620X.104B3.BJJ-2021-1320.R1.
The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI.
We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified.
Overall, 31 studies were identified: 20 described PCR, six described IL6, and five calprotectin. The sensitivity and specificity were 0.78 (95% confidence interval (CI) 0.67 to 0.86) and 0.97 (95% CI 0.94 to 0.99), respectively, for synovial PCR;, 0.86 (95% CI 0.74 to 0.92), and 0.94 (95% CI 0.90 to 0.96), respectively, for synovial IL6; and 0.94 (95% CI 0.82 to 0.98) and 0.93 (95% CI 0.85 to 0.97), respectively, for synovial calprotectin. Likelihood ratio scattergram analyses recommended clinical utility of synovial fluid PCR and IL6 as a confirmatory test only. Synovial calprotectin had utility in the exclusion and confirmation of PJI.
Synovial fluid PCR and IL6 had low sensitivity and high specificity in the diagnosis of PJI, and is recommended to be used as confirmatory test. In contrast, synovial fluid calprotectin had both high sensitivity and specificity with utility in both the exclusion and confirmation of PJI. We recommend use of synovial fluid calprotectin studies in the preoperative workup of PJI. Cite this article: 2022;104-B(3):311-320.
由于缺乏既敏感又特异的生物标志物，假体周围关节感染（PJI）的术前诊断仍然具有挑战性。我们研究了滑液聚合酶链反应（PCR）、白细胞介素-6（IL6）和钙卫蛋白在 PJI 诊断中的性能特征。
我们对 PubMed、Embase、The Cochrane Library、Web of Science 和 Science Direct 进行了系统检索，检索时间从每个数据库的创建日期开始，一直持续到 2021 年 5 月 31 日。我们确定了描述使用肌肉骨骼感染学会标准作为参考标准的滑液 PCR、IL6 和钙卫蛋白的诊断准确性的研究。
共确定了 31 项研究：20 项描述了 PCR，6 项描述了 IL6，5 项描述了钙卫蛋白。滑液 PCR 的敏感性和特异性分别为 0.78（95%置信区间 0.67 至 0.86）和 0.97（95%置信区间 0.94 至 0.99）；滑液 IL6 的敏感性和特异性分别为 0.86（95%置信区间 0.74 至 0.92）和 0.94（95%置信区间 0.90 至 0.96）；滑液钙卫蛋白的敏感性和特异性分别为 0.94（95%置信区间 0.82 至 0.98）和 0.93（95%置信区间 0.85 至 0.97）。似然比散点图分析建议仅将滑液 PCR 和 IL6 用作确认试验。滑液钙卫蛋白在 PJI 的排除和确认中具有实用性。
滑液 PCR 和 IL6 对 PJI 的诊断具有低敏感性和高特异性，建议将其作为确认试验。相比之下，滑液钙卫蛋白具有较高的敏感性和特异性，在 PJI 的排除和确认中均具有实用性。我们建议在 PJI 的术前评估中使用滑液钙卫蛋白研究。
