Aggarwal Pankaj, Mahapatra Swagat, Avasthi Sachin, Aslam Ammar, Kumar Vineet
Department of Orthopaedics, Dr RMLIMS, Lucknow, India.
J Clin Orthop Trauma. 2022 Jul 10;31:101948. doi: 10.1016/j.jcot.2022.101948. eCollection 2022 Aug.
Septic arthritis is a serious orthopaedic emergency that must be diagnosed and managed early to prevent devastating complications. The current gold standard for diagnosing septic arthritis is synovial fluid culture, but results are delayed by 48-72 h, and the sensitivity of the test is very low. Differentiating Septic from non-septic arthritis is vital to prevent unnecessary use of antibiotics and prevent complications. Serum Procalcitonin (PCT) is a useful marker in differentiating septic from non-septic arthritis but there are very few studies that have studied the role of synovial PCT for the same.
To determine the role of serum and synovial PCT in differentiating acute Septic from non-septic arthritis.
Prospective clinical study in which 60 patients presenting with acute inflammatory arthritis (<2 weeks duration) were enrolled from May 2018 to May 2020. Serum and synovial fluid samples were drawn at presentation and routine blood investigations, synovial fluid culture sensitivity, and Procalcitonin levels were measured. Patients were divided into 3 groups, with group-1 having confirmed pyogenic, group-2 having presumed pyogenic, and group-3 having non -pyogenic patients, respectively. All data was tabulated and statistically analysed using appropriate tests.
Mean serum PCT values in groups 1, 2 and 3 were 1.06 ± 1.11, 0.85 ± 0.74, and 0.11 ± 0.24, respectively. Patients in the Pyogenic group (group1 and group 2) had significantly higher mean serum PCT as compared to group3 (p < 0.0001). Group 1 had higher serum PCT as compared to group 2, but the difference was not significant (p = 0.58). Mean synovial PCT in group 1, 2 and 3 were 2.42 ± 1.98, 1.89 ± 1.18, and 0.22 ± 0.40, respectively. Patients in the Pyogenic group (Group1 and Group2) had significantly higher mean synovial PCT as compared to Group 3 (p < 0.0001). Group 1 had higher mean synovial PCT as compared to group 2, but the difference was not significant (p = 0.54). The area under the ROC curve of the serum levels of PCT was 0.0.895, and the area under the ROC curve of the synovial fluid levels of PCT was 0.914, which was higher than the serum PCT level.
Serum and synovial Procalcitonin may be used as a diagnostic marker in differentiating septic from inflammatory arthritis and can help in reducing unnecessary use of antibiotics and early diagnosis and management of septic arthritis, thereby preventing complications.
化脓性关节炎是一种严重的骨科急症，必须尽早诊断和处理以预防严重并发症。目前诊断化脓性关节炎的金标准是滑膜液培养，但结果会延迟48 - 72小时，且该检测的敏感性很低。区分化脓性关节炎与非化脓性关节炎对于避免不必要地使用抗生素及预防并发症至关重要。血清降钙素原（PCT）是区分化脓性与非化脓性关节炎的一个有用标志物，但针对滑膜PCT在这方面作用的研究非常少。
确定血清和滑膜PCT在区分急性化脓性关节炎与非化脓性关节炎中的作用。
一项前瞻性临床研究，于2018年5月至2020年5月纳入60例表现为急性炎症性关节炎（病程<2周）的患者。在就诊时采集血清和滑膜液样本，并进行常规血液检查、滑膜液培养敏感性检测及降钙素原水平测定。患者分为3组，第1组为确诊化脓性患者，第2组为疑似化脓性患者，第3组为非化脓性患者。所有数据制成表格，并使用适当的检验进行统计学分析。
第1、2和3组的平均血清PCT值分别为1.06±1.11、0.85±0.74和0.11±0.24。化脓性组（第1组和第2组）患者的平均血清PCT显著高于第3组（p<0.0001）。第1组的血清PCT高于第2组，但差异不显著（p = 0.58）。第1、2和3组的平均滑膜PCT分别为2.42±1.98、1.89±1.18和0.22±0.40。化脓性组（第1组和第2组）患者的平均滑膜PCT显著高于第3组（p<0.0001）。第1组的平均滑膜PCT高于第2组，但差异不显著（p = 0.54）。血清PCT水平的ROC曲线下面积为0.895，滑膜液PCT水平的ROC曲线下面积为0.914，高于血清PCT水平。
血清和滑膜降钙素原可作为区分化脓性关节炎与炎症性关节炎的诊断标志物，有助于减少不必要的抗生素使用，并实现化脓性关节炎的早期诊断和处理，从而预防并发症。
