Department of Bone and Joint Surgery, Department of Orthopedics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ministry of Education Engineering Research Center of Cell & Therapeutic Antibody, School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China.
Orthop Surg. 2022 Nov;14(11):2822-2836. doi: 10.1111/os.13500. Epub 2022 Oct 1.
The current diagnostic criteria for periprosthetic joint infection (PJI) are diverse and controversial, leading to delayed diagnosis. This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage.
We searched the MEDLINE and Embase databases for retrospective or prospective studies which reported preoperative-available assays (serum, synovial, or culture tests) for the diagnosis of chronic PJI among inflammatory arthritis (IA) or non-IA populations from January 1, 2000 to June 30, 2022. Threshold effective analysis was performed on synovial polymorphonuclear neutrophils (PMN%), synovial white blood cell (WBC), serum C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to find the relevant cut-offs.
Two hundred and sixteen studies and information from 45,316 individuals were included in the final analysis. Synovial laboratory-based α-defensin and calprotectin had the best comprehensive sensitivity (0.91 [0.86-0.94], 0.95 [0.88-0.98]) and specificity (0.96 [0.94-0.97], 0.95 [0.89-0.98]) values. According to the threshold effect analysis, the recommended cut-offs are 70% (sensitivity 0.89 [0.85-0.92], specificity 0.90 [0.87-0.93]), 4100/μL (sensitivity 0.90 [0.87-0.93], specificity 0.97 [0.93-0.98]), 13.5 mg/L (sensitivity 0.84 [0.78-0.89], specificity 0.83 [0.73-0.89]), and 30 mm/h (sensitivity 0.79 [0.74-0.83], specificity 0.78 [0.72-0.83]) for synovial PMN%, synovial WBC, serum CRP, and ESR, respectively, and tests seem to be more reliable among non-IA patients.
The laboratory-based synovial α-defensin and synovial calprotectin are the two best independent preoperative diagnostic tests for PJI. A cut off of 70% for synovial PMN% and tighter cut-offs for synovial WBC and serum CRP could have a better diagnostic accuracy for non-IA patients with chronic PJI.
目前，假体周围关节感染（PJI）的诊断标准多种多样且存在争议，导致诊断延误。本研究旨在评估和统一早期 PJI 的血清和滑膜常规检测的诊断准确性和阈值选择。
我们检索了 MEDLINE 和 Embase 数据库，以获取 2000 年 1 月 1 日至 2022 年 6 月 30 日期间关于炎性关节炎（IA）或非 IA 人群中慢性 PJI 术前可用检测（血清、滑膜或培养检测）的回顾性或前瞻性研究。我们对滑膜多形核中性粒细胞（PMN%）、滑膜白细胞（WBC）、血清 C 反应蛋白（CRP）和红细胞沉降率（ESR）进行了阈效分析，以找到相关的截止值。
最终分析纳入了 216 项研究和来自 45316 人的信息。基于滑膜的 α-防御素和钙卫蛋白具有最佳的综合敏感性（0.91 [0.86-0.94]，0.95 [0.88-0.98]）和特异性（0.96 [0.94-0.98]，0.95 [0.89-0.98]）值。根据阈效分析，推荐的截止值分别为 70%（敏感性 0.89 [0.85-0.92]，特异性 0.90 [0.87-0.93]）、4100/μL（敏感性 0.90 [0.87-0.93]，特异性 0.97 [0.93-0.98]）、13.5mg/L（敏感性 0.84 [0.78-0.89]，特异性 0.83 [0.73-0.89]）和 30mm/h（敏感性 0.79 [0.74-0.83]，特异性 0.78 [0.72-0.83]），用于滑膜 PMN%、滑膜 WBC、血清 CRP 和 ESR，且这些检测在非 IA 患者中似乎更可靠。
基于滑膜的 α-防御素和滑膜钙卫蛋白是两种最好的独立 PJI 术前诊断检测。滑膜 PMN%的截止值为 70%，滑膜 WBC 和血清 CRP 的截止值更严格，可能对非 IA 慢性 PJI 患者具有更好的诊断准确性。
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