Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, No.137 South Li Yu Shan Road, Urumqi, 830054, Xinjiang, China.
BMC Musculoskelet Disord. 2022 Mar 26;23(1):292. doi: 10.1186/s12891-022-05199-8.
Although many markers are used for diagnosis of periprosthetic joint infection (PJI), serological screening and diagnosis for PJI are still challenging. We evaluated the performance of serum D-lactate and compared it with ESR, coagulation-related biomarkers and synovial D-lactate for the diagnosis of PJI.
Consecutive patients with preoperative blood and intraoperative joint aspiration of a prosthetic hip or knee joint before revision arthroplasty were prospectively included. The diagnosis of PJI was based on the criteria of the Musculoskeletal Infection Society, and the diagnostic values of markers were estimated based on receiver operating characteristic (ROC) curves by maximizing sensitivity and specificity using optimal cutoff values.
Of 52 patients, 26 (50%) were diagnosed with PJI, and 26 (50%) were diagnosed with aseptic failure. ROC curves showed that serum D-lactate, fibrinogen (FIB) and ESR had equal areas under the curve (AUCs) of 0.80, followed by D-dimer and fibrin degradation product, which had AUCs of 0.67 and 0.69, respectively. Serum D-lactate had the highest sensitivity of 88.46% at the optimal threshold of 1.14 mmol/L, followed by FIB and ESR, with sensitivities of 80.77% and 73.08%, respectively, while there were no significant differences in specificity (73.08%, 73.08% and 76.92%, respectively).
Serum D-lactate showed similar performance to FIB and ESR for diagnosis of PJI. The advantages of serum D-lactate are pathogen-specific, highly sensitive, minimally invasive and rapidly available making serum D-lactate useful as a point-of-care screening test for PJI.
尽管有许多标志物用于诊断假体周围关节感染（PJI），但血清学筛查和诊断 PJI 仍然具有挑战性。我们评估了血清 D-乳酸的性能，并将其与 ESR、凝血相关生物标志物和关节滑液 D-乳酸进行比较，以诊断 PJI。
前瞻性纳入了因翻修关节置换术前髋关节或膝关节假体术前血液和术中关节抽吸的连续患者。PJI 的诊断基于肌肉骨骼感染学会的标准，通过使用最佳截断值最大化敏感性和特异性来估计标志物的诊断价值，基于接收器操作特征（ROC）曲线。
在 52 名患者中，26 名（50%）被诊断为 PJI，26 名（50%）被诊断为无菌性失败。ROC 曲线显示血清 D-乳酸、纤维蛋白原（FIB）和 ESR 的曲线下面积（AUC）相等，为 0.80，其次是 D-二聚体和纤维蛋白降解产物，AUC 分别为 0.67 和 0.69。血清 D-乳酸在最佳阈值 1.14mmol/L 时具有最高的敏感性 88.46%，其次是 FIB 和 ESR，敏感性分别为 80.77%和 73.08%，而特异性无显著差异（分别为 73.08%、73.08%和 76.92%）。
血清 D-乳酸对 PJI 的诊断表现与 FIB 和 ESR 相似。血清 D-乳酸的优势在于其病原体特异性、高灵敏度、微创和快速可用性，使其成为 PJI 的一种有用的即时护理筛查试验。
