Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Department of Orthopaedics, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China.
Orthop Surg. 2023 Sep;15(9):2328-2333. doi: 10.1111/os.13810. Epub 2023 Jul 12.
Significant progress has been made in recent years in the diagnosis of periprosthetic joint infections (PJI). However, the lack of a gold standard test for the diagnosis of PJI remains a challenge.The aim of this study was to evaluate the diagnostic values of the albumin/fibrinogen ratio (AFR), the C-reactive protein/albumin ratio (CAR), and the levels of fibrinogen (FIB) and albumin (ALB) in the diagnosis of PJI.
The medical records of 158 patients who had undergone hip or knee revisions from January 2018 to May 2022 were retrospectively analyzed. Of these patients, 79 were diagnosed with PJI, while 79 were diagnosed with aseptic loosening (AL). PJI was defined using the Musculoskeletal Infection Society criteria. The plasma levels of C-reactive protein (CRP), ALB, and FIB; the erythrocyte sedimentation rate (ESR); and the AFR and CAR in the two groups were recorded and analyzed. The receiver operating characteristic curve was used to calculate the sensitivity and specificity of each indicator; the diagnostic value for each indicator was calculated as the area under the curve (AUC).
The ESR, CRP, FIB, and CAR values in the PJI group were significantly higher than those in the AL group, and the ALB and AFR values were significantly lower than those in the AL group (p < 0.001). The AUC values of AFR and fibrinogen were 0.851 and 0.848, respectively, which were slightly higher than those of CRP (0.826) and ESR (0.846). The AUC of CAR was 0.831 which was slightly lower than that of CRP (0.846). ALB had an AUC of 0.727. The optimal threshold, sensitivity, and specificity, respectively, were 10.05, 84.81%, and 82.28% for AFR; 4.03 μg/mL, 77.22%, and 86.08% for FIB; 0.23, 72.15%, and 82.28% for CAR; and 37.30 g/L, 65.82%, and 73.42% for ALB.
AFR, CAR, and FIB are good new auxiliary diagnostic indicators of PJI, while ALB is of fair value for the diagnosis of PJI.
近年来，在假体周围关节感染（PJI）的诊断方面取得了显著进展。然而，缺乏诊断 PJI 的金标准测试仍然是一个挑战。本研究旨在评估白蛋白/纤维蛋白原比值（AFR）、C 反应蛋白/白蛋白比值（CAR）以及纤维蛋白原（FIB）和白蛋白（ALB）水平在 PJI 诊断中的诊断价值。
回顾性分析了 2018 年 1 月至 2022 年 5 月期间接受髋关节或膝关节翻修手术的 158 例患者的病历。其中，79 例患者被诊断为 PJI，79 例被诊断为无菌性松动（AL）。PJI 的定义采用肌肉骨骼感染学会标准。记录并分析两组患者的 C 反应蛋白（CRP）、ALB、FIB 血浆水平、红细胞沉降率（ESR）以及 AFR 和 CAR。使用受试者工作特征曲线计算每个指标的灵敏度和特异性；将每个指标的诊断价值计算为曲线下面积（AUC）。
PJI 组的 ESR、CRP、FIB 和 CAR 值明显高于 AL 组，ALB 和 AFR 值明显低于 AL 组（p<0.001）。AFR 和纤维蛋白原的 AUC 值分别为 0.851 和 0.848，略高于 CRP（0.826）和 ESR（0.846）。CAR 的 AUC 值为 0.831，略低于 CRP（0.846）。ALB 的 AUC 值为 0.727。AFR 的最佳截断值、灵敏度和特异性分别为 10.05、84.81%和 82.28%；FIB 的最佳截断值、灵敏度和特异性分别为 4.03μg/mL、77.22%和 86.08%；CAR 的最佳截断值、灵敏度和特异性分别为 0.23、72.15%和 82.28%；ALB 的最佳截断值、灵敏度和特异性分别为 37.30g/L、65.82%和 73.42%。
AFR、CAR 和 FIB 是 PJI 的较好的新辅助诊断指标，而 ALB 对 PJI 的诊断具有一定价值。
