Liu Hanjiang, Yu Yali, Niu Yanli
Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, People's Republic of China.
School of Basic Medical Science, Henan University, Kaifeng, Henan, 475004, People's Republic of China.
Infect Drug Resist. 2022 May 2;15:2393-2400. doi: 10.2147/IDR.S355180. eCollection 2022.
The discrimination of prosthetic joint infection (PJI) from aseptic failure is regarded as a major clinical challenge. The key function of human neutrophil lipocalin (HNL) in regulating bacterial infection rationalizes its potential as a biomarker to diagnose PJI. This work evaluated the accuracy of serum human neutrophil lipocalin as a biomarker to diagnose PJI.
This prospective cohort study enrolled altogether 58 patients suffering from miserable knee or hip arthroplasty and receiving revision surgery from 2018 to 2020. Related laboratory and clinical information of these patients were retrieved. Following the Musculoskeletal Infection Society (MSIS) criteria, the diagnosis of PJI was conducted. Collecting preoperative blood samples, we measured HNL by the standard assay. Thereafter, plotting the receiver-operating characteristic curve (ROC), the area under the curve (AUC) values were calculated to analyze the diagnosis accuracy.
According to the MSIS criteria, 38 cases (65.5%) were classified into the PJI group, while 20 (34.5%) into the aseptic loosening group, with age ranging from 38 to 87 (median, 66.9) years. The median serum HNL level of the PJI patients was 199.01 (range, 85.34-357.79) ng/mL, significantly higher as compared with that of 64.81 (range, 20.73-157.89) ng/mL of the aseptic loosening group. Using the Youden index, the optimal threshold value was 105.1ng/mL, while the specificity, sensitivity, and AUC were 85.0%, 81.6%, and 0.919, respectively.
Serum HNL is the creditable test that can be employed as the laboratory biomarker to screen PJI. The threshold HNL level is 105.1 ng/mL, which may distinguish PJI from aseptic failure.
区分假体关节感染（PJI）与无菌性松动是一项重大的临床挑战。人中性粒细胞脂质运载蛋白（HNL）在调节细菌感染中的关键作用使其有潜力成为诊断PJI的生物标志物。本研究评估了血清人中性粒细胞脂质运载蛋白作为诊断PJI生物标志物的准确性。
这项前瞻性队列研究共纳入了58例在2018年至2020年期间接受膝关节或髋关节置换术并接受翻修手术的患者。收集了这些患者的相关实验室和临床信息。根据肌肉骨骼感染学会（MSIS）标准进行PJI的诊断。采集术前血样，采用标准检测方法测定HNL。之后，绘制受试者操作特征曲线（ROC），计算曲线下面积（AUC）值以分析诊断准确性。
根据MSIS标准，38例（65.5%）被分类为PJI组，20例（34.5%）为无菌性松动组，年龄范围为38至87岁（中位数为66.9岁）。PJI患者血清HNL水平中位数为199.01（范围为85.34 - 357.79）ng/mL，显著高于无菌性松动组的64.81（范围为20.73 - 157.89）ng/mL。采用约登指数，最佳阈值为105.1ng/mL，特异性、敏感性和AUC分别为85.0%、81.6%和0.919。
血清HNL是一种可靠的检测方法，可作为筛查PJI的实验室生物标志物。HNL的阈值水平为105.1 ng/mL，可用于区分PJI与无菌性松动。
