Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Center for General Education, Cheng Shiu University, Kaohsiung, Taiwan.
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
J Arthroplasty. 2022 Oct;37(10):2076-2081. doi: 10.1016/j.arth.2022.05.002. Epub 2022 May 7.
The aim of this study was to evaluate the diagnostic performance of minor criteria from the 2018 International Consensus Meeting (ICM) for the diagnosis of chronic periprosthetic joint infection (PJI) in an Asian population.
We retrospectively reviewed 76 patients who underwent a revision knee or hip arthroplasty at an academic institution between September 2018 and December 2019. All major and minor 2018 ICM criteria were available for all patients included. Cases with at least 1 major criterion or score ≥6 in minor criteria were considered as infected. The diagnostic performance was evaluated by a receiver operative characteristic curve analysis and area under the curve (AUC) for each minor criterion. An AUC value of more than 0.9 was considered outstanding and 0.8-0.9 as excellent.
When using 2018 ICM threshold, the diagnostic performance ranked based on AUC was the following: alpha defensin (0.92), positive histology (0.83), leukocyte esterase (0.82), synovial white blood cell (0.81), serum erythrocyte sedimentation rate (0.78), synovial polymorphonuclear neutrophils (0.77), serum C-reactive protein (0.74), D-dimer (0.59), single positive culture (0.53), and positive intraoperative purulence (0.51). Alpha defensin was considered as an outstanding test among the 2018 ICM minor criteria. Positive histology, leukocyte esterase, and synovial white blood cell were considered as excellent tests.
Based on our findings, alpha-defensin has the best diagnostic performance in Asian population among the minor criteria of 2018 ICM.
本研究旨在评估 2018 年国际共识会议（ICM）中用于诊断慢性人工关节周围感染（PJI）的次要标准在亚洲人群中的诊断性能。
我们回顾性分析了 2018 年 9 月至 2019 年 12 月在一所学术机构接受翻修膝关节或髋关节置换术的 76 名患者。所有患者均具有所有纳入的主要和次要 2018 年 ICM 标准。至少有 1 项主要标准或次要标准得分≥6 分的病例被认为是感染病例。通过受试者工作特征曲线分析和曲线下面积（AUC）评估每个次要标准的诊断性能。AUC 值大于 0.9 被认为是优秀的，0.8-0.9 为良好。
当使用 2018 年 ICM 阈值时，根据 AUC 排列的诊断性能排名如下：α防御素（0.92）、阳性组织学（0.83）、白细胞酯酶（0.82）、滑膜白细胞（0.81）、血清红细胞沉降率（0.78）、滑膜多形核白细胞（0.77）、血清 C 反应蛋白（0.74）、D-二聚体（0.59）、单阳性培养（0.53）和术中脓性分泌物（0.51）。α防御素被认为是 2018 年 ICM 次要标准中表现最好的测试。阳性组织学、白细胞酯酶和滑膜白细胞被认为是优秀的测试。
根据我们的发现，α-防御素在亚洲人群中 2018 年 ICM 次要标准中的诊断性能最佳。
