Department of Orthopaedics, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Department of Orthopaedics, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China.
BMC Musculoskelet Disord. 2022 Apr 30;23(1):404. doi: 10.1186/s12891-022-05357-y.
To evaluate the relative performance of clinical readouts including serum C-reactive protein (CRP) levels, the erythrocyte sedimentation rate (ESR), globulin (GLB) levels, the albumin to GLB ratio (A/G), and the neutrophil to lymphocyte ratio (NLR) when diagnosing periprosthetic joint infection (PJI).
Clinical data was collected from 115 individuals diagnosed in our department between January 2017 and December 2020 with either chronic PJI (29 female, 24 male; median age 71.00 years [range, 41-94 years]) or aseptic loosening (30 female, 32 male; median age 68.50 years [range, 34-85 years]). Patient demographic data were compared, and the relative sensitivity and specificity of preoperative GLB, ESR, CRP, NLR, and A/G values as predictors of PJI diagnosis were assessed.
Median globulin levels in the PJI and aseptic groups were 31.700 g/L (interquartile range [IQR], 28.400-35.300) and 26.600 g/L (IQR, 24.375-30.550), respectively (p < 0.001). The median A/G values in the PJI and aseptic groups were 1.150 (IQR, 0.960-1.255) and 1.510 (IQR, 1.265-1.670), respectively (p < 0.001). The median NLR values in the PJI and aseptic groups were 2.510 (IQR, 1.900-3.335) and 1.850 (IQR, 1.425 to 2.362), respectively (p < 0.001). The median ESR values in the PJI and aseptic groups were 53.000 mm/h (IQR, 35.000-76.500) and 16.000 mm/h (IQR, 7.000-33.000), respectively (p < 0.001). Median CRP levels in the PJI and aseptic groups were 24.890 mg/L (IQR, 10.595-54.095) and 2.245 mg/L (IQR, 0.865-8.6075), respectively (p < 0.001). Area under the receiver operating characteristic (ROC) curve (AUC) values for CRP, ESR, GLB, A/G, and NLR were 0.841 (95% confidence interval, 0.761-0.903), 0.850 (0.771-0.910), 0.747 (0.658-0.824), 0.779 (0.692-0.851), and 0.708 (0.616-0.789), respectively. When GLB > 26.6 g/L, A/G < 1.32, and NLR > 2.1 were utilized as threshold values to diagnose PJI, GLB and A/G were found to exhibit superior sensitivity (90.57%, 81.13%) to that observed for CRP (71.70%) and ESR (79.25%), but the specificity of these two metrics (GLB: 51.61%, A/G: 72.58%) was significantly reduced relative to that for CRP (87.10%) or ESR (75.81%). ROC analyses further revealed that NLR did not exhibit significant advantages in sensitivity (73.58%) or specificity (70.97%) relative to CRP or ESR.
Globulin levels, NLR values, and A/G values do not outperform ESR or CRP levels when used to diagnose PJI.
评估包括血清 C 反应蛋白 (CRP) 水平、红细胞沉降率 (ESR)、球蛋白 (GLB) 水平、白蛋白与球蛋白比值 (A/G) 和中性粒细胞与淋巴细胞比值 (NLR) 等临床检测指标在诊断假体周围关节感染 (PJI) 时的相对性能。
收集了 2017 年 1 月至 2020 年 12 月在我科诊断为慢性 PJI（29 名女性，24 名男性；中位年龄 71.00 岁[范围，41-94 岁]）或无菌性松动（30 名女性，32 名男性；中位年龄 68.50 岁[范围，34-85 岁]）的 115 名患者的临床数据。比较患者的人口统计学数据，并评估术前 GLB、ESR、CRP、NLR 和 A/G 值作为 PJI 诊断预测指标的相对敏感性和特异性。
PJI 组和无菌性松动组的球蛋白中位数分别为 31.700 g/L（四分位距 [IQR]，28.400-35.300）和 26.600 g/L（IQR，24.375-30.550）（p < 0.001）。PJI 组和无菌性松动组的 A/G 值中位数分别为 1.150（IQR，0.960-1.255）和 1.510（IQR，1.265-1.670）（p < 0.001）。PJI 组和无菌性松动组的 NLR 值中位数分别为 2.510（IQR，1.900-3.335）和 1.850（IQR，1.425 至 2.362）（p < 0.001）。PJI 组和无菌性松动组的 ESR 值中位数分别为 53.000 mm/h（IQR，35.000-76.500）和 16.000 mm/h（IQR，7.000-33.000）（p < 0.001）。PJI 组和无菌性松动组的 CRP 水平中位数分别为 24.890 mg/L（IQR，10.595-54.095）和 2.245 mg/L（IQR，0.865-8.6075）（p < 0.001）。CRP、ESR、GLB、A/G 和 NLR 的接受者操作特征（ROC）曲线下面积（AUC）值分别为 0.841（95%置信区间，0.761-0.903）、0.850（0.771-0.910）、0.747（0.658-0.824）、0.779（0.692-0.851）和 0.708（0.616-0.789）。当 GLB > 26.6 g/L、A/G < 1.32 和 NLR > 2.1 用作诊断 PJI 的阈值时，发现 GLB 和 A/G 的敏感性（90.57%、81.13%）优于 CRP（71.70%）和 ESR（79.25%），但这两个指标的特异性（GLB：51.61%、A/G：72.58%）明显低于 CRP（87.10%）或 ESR（75.81%）。ROC 分析进一步表明，NLR 的敏感性（73.58%）或特异性（70.97%）与 CRP 或 ESR 相比没有显著优势。
在诊断 PJI 时，球蛋白水平、NLR 值和 A/G 值的性能并不优于 ESR 或 CRP 水平。
