Loppini Mattia, Di Maio Marco, Avigni Roberta, Leone Roberto, Inforzato Antonio, Grappiolo Guido, Mantovani Alberto, Bottazzi Barbara
IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy.
J Clin Med. 2023 Jan 29;12(3):1055. doi: 10.3390/jcm12031055.
Preoperative diagnosis of periprosthetic joint infections (PJIs) poses an unmet clinical challenge. The long pentraxin PTX3 is a component of the innate immune system involved in infection immunity. This study evaluated the potential of synovial and plasmatic PTX3 in the diagnosis of hip and knee PJIs.
Consecutive total hip and knee arthroplasty (THA/TKA) revisions were prospectively included and classified as septic or aseptic according to the European Bone and Joint Infection Society (EBJIS) and Musculoskeletal Infection Society (MSIS) criteria. The concentration of PTX3 in plasma and synovial fluid samples was measured with ELISA. The AUC, threshold value, sensitivity, specificity, and positive and negative likelihood ratios were calculated using the ROC (receiver operating characteristic) curve method.
The study population included 128 patients (94 THAs; 34 TKAs). The AUC of the synovial PTX3 based on EBJIS criteria was 0.85 ( < 0.0001), with a sensitivity of 81.13% and a specificity of 93.33%. The AUC based on MSIS criteria was 0.95 ( < 0.001), with a sensitivity of 91.43% and a specificity of 89.25%. Plasmatic PTX3 failed to discriminate infected from non-infected patients.
Synovial PTX3 demonstrated an excellent diagnostic potential in hip and knee PJIs, with a very high specificity irrespective of the diagnostic criteria for PJI.
人工关节周围感染（PJI）的术前诊断是一项尚未解决的临床挑战。长五聚蛋白3（PTX3）是参与感染免疫的固有免疫系统的一个组成部分。本研究评估了滑膜和血浆中PTX3在髋和膝PJI诊断中的潜力。
前瞻性纳入连续的全髋关节和膝关节置换术（THA/TKA）翻修病例，并根据欧洲骨与关节感染学会（EBJIS）和肌肉骨骼感染学会（MSIS）的标准分为感染性或无菌性。用酶联免疫吸附测定法（ELISA）测量血浆和滑液样本中PTX3的浓度。使用ROC（受试者工作特征）曲线法计算曲线下面积（AUC）、阈值、敏感性、特异性以及阳性和阴性似然比。
研究人群包括128例患者（94例THA；34例TKA）。基于EBJIS标准的滑膜PTX3的AUC为0.85（<0.0001），敏感性为81.13%，特异性为93.33%。基于MSIS标准的AUC为0.95（<0.001），敏感性为91.43%，特异性为89.25%。血浆PTX3无法区分感染患者和未感染患者。
滑膜PTX3在髋和膝PJI中显示出优异的诊断潜力，无论PJI的诊断标准如何，其特异性都非常高。
