Xu Hong, Xie Jinwei, Zhang Shaoyun, Wang Duan, Huang Zeyu, Zhou Zongke
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China.
Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, China.
Antibiotics (Basel). 2022 Apr 11;11(4):505. doi: 10.3390/antibiotics11040505.
Blood biomarkers are first-line tools for identifying periprosthetic joint infection (PJI). C-reactive protein (CRP) is currently recognized as the standard biomarker for PJI diagnosis. Other recently reported novel biomarkers, including plasma fibrinogen, platelet count, monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), and platelet count/lymphocyte ratio (PLR), have also shown promise in diagnosing PJI. This study aimed to evaluate whether these biomarkers were superior to CRP for identifying PJI.
Patients who underwent revision hip or knee arthroplasty at our hospital from January 2008 to September 2020 were included consecutively and divided into infected and non-infected groups according to the 2013 International Consensus Meeting Criteria. Blood samples were collected preoperatively, and erythrocyte sedimentation rate (ESR), CRP, interleukin-6, fibrinogen, platelet count, MLR, NLR, and PLR were analyzed. The diagnostic values of the tested biomarkers and their combinations were compared with CRP based on the area under the receiver operating characteristic curve (AUC) using the z-test. Classification trees were constructed to explore more accurate combinations of the tested markers for identifying PJI.
A total of 543 patients were included, of whom 245 had PJI. Among the tested biomarkers, CRP with a cutoff of 7.39 mg/L showed the highest AUC, which gave a sensitivity of 79.1% and specificity of 86.0%. The AUCs of pairwise combinations of tested markers including CRP also were inferior to CRP itself, as were combinations derived from classification trees.
Preoperative serum CRP with a low cutoff may be the best reliable blood biomarker for identifying PJI, and those traditional or novel available blood biomarkers could not further improve the diagnostic ability on the basis of CRP.
血液生物标志物是用于识别假体周围关节感染（PJI）的一线工具。C反应蛋白（CRP）目前被认为是PJI诊断的标准生物标志物。其他最近报道的新型生物标志物，包括血浆纤维蛋白原、血小板计数、单核细胞/淋巴细胞比值（MLR）、中性粒细胞/淋巴细胞比值（NLR）和血小板计数/淋巴细胞比值（PLR），在PJI诊断中也显示出前景。本研究旨在评估这些生物标志物在识别PJI方面是否优于CRP。
连续纳入2008年1月至2020年9月在我院接受髋关节或膝关节翻修置换术的患者，并根据2013年国际共识会议标准分为感染组和非感染组。术前采集血样，分析红细胞沉降率（ESR）、CRP、白细胞介素-6、纤维蛋白原、血小板计数、MLR、NLR和PLR。使用z检验，基于受试者操作特征曲线（AUC）下的面积，将测试生物标志物及其组合的诊断价值与CRP进行比较。构建分类树以探索用于识别PJI的测试标志物的更准确组合。
共纳入543例患者，其中245例患有PJI。在测试的生物标志物中，临界值为7.39 mg/L的CRP显示出最高的AUC，灵敏度为79.1%，特异性为86.0%。包括CRP在内的测试标志物的两两组合的AUC也低于CRP本身，分类树得出的组合也是如此。
低临界值的术前血清CRP可能是识别PJI的最佳可靠血液生物标志物，那些传统的或现有的新型血液生物标志物在CRP的基础上不能进一步提高诊断能力。
