中性粒细胞与淋巴细胞比值和淋巴细胞与单核细胞比值与慢性人工关节感染相关，但对其诊断无显著意义。
Neutrophil-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis.
机构信息
ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
出版信息
Arch Orthop Trauma Surg. 2024 Jan;144(1):297-305. doi: 10.1007/s00402-023-05052-0. Epub 2023 Oct 24.
PURPOSE
To investigate reported correlations between Neutrophil-to-Lymphocyte (NLR) and Lymphocyte-to-Monocyte (LMR) ratios and their value in diagnosis of chronic prosthetic joint infection (PJI) in a large cohort of patients from a single specialist hospital.
METHODS
Diagnostic aspirations of 362 patients under investigation for PJI were identified. Of the included patients 185 patients received a final diagnosis of PJI and 177 were classed as aseptic. Established criteria (ICM 2018) were employed to define PJI. Included in the analysis are differential white cell counts, C-Reactive Protein (CRP), Synovial Leukocyte Count, Synovial Alpha-defensin ELISA and Synovial Leukocyte esterase activity. Receiver-operator characteristic (ROC) curves were calculated for each of the available diagnostic tests together with the corresponding area under the curve values (AUC). Youden's index was utilized to identify the optimal diagnostic threshold point for the NLR and LMR. Other diagnostic tests were evaluated as per the threshold values previously defined in the literature and specified in the ICM criteria.
RESULTS
Using Youden's Index to identify the optimal NLR cut-off within our cohort we established a value of 2.93. This yielded a sensitivity of 0.60 and specificity of 0.64. The area under the curve (AUC) of a receiving operator characteristics (ROC) curve was 0.625. Regarding the LMR the results demonstrate similar findings; a positive correlation with a diagnosis of infection but poor sensitivity and specificity. The AUC for LMR was 0.633 and was not superior to NLR (P = 0.753).
CONCLUSIONS
There is a significant correlation between higher Neutrophil-Lymphocyte and Lymphocyte-Monocyte ratios, and a diagnosis of PJI. The sensitivity and specificity of this calculation is poor and the does not add value to the diagnostic algorithm for PJI.
LEVEL OF EVIDENCE
Level III Retrospective Cohort analysis.
目的
在一家专业医院的大样本患者队列中，研究中性粒细胞与淋巴细胞（NLR）和淋巴细胞与单核细胞（LMR）比值的报告相关性及其在慢性人工关节感染（PJI）诊断中的价值。
方法
确定了 362 名疑似 PJI 患者的诊断性抽吸。在纳入的患者中，185 名患者被诊断为 PJI，177 名患者被归类为无菌性。采用既定标准（ICM 2018）定义 PJI。分析包括白细胞分类计数、C 反应蛋白（CRP）、滑膜白细胞计数、滑膜α-防御素 ELISA 和滑膜白细胞酯酶活性。为每个可用的诊断测试计算了接收者操作特征（ROC）曲线以及相应的曲线下面积值（AUC）。使用 Youden 指数确定 NLR 和 LMR 的最佳诊断阈值点。根据文献中先前定义的阈值和 ICM 标准评估其他诊断测试。
结果
使用 Youden 指数在我们的队列中确定 NLR 的最佳截断值，我们确定了 2.93 的值。这产生了 0.60 的敏感性和 0.64 的特异性。接收者操作特征（ROC）曲线的曲线下面积（AUC）为 0.625。关于 LMR，结果显示出相似的发现；与感染诊断呈正相关，但敏感性和特异性差。LMR 的 AUC 为 0.633，并不优于 NLR（P=0.753）。
结论
较高的中性粒细胞与淋巴细胞和淋巴细胞与单核细胞比值与 PJI 的诊断有显著相关性。这种计算的敏感性和特异性较差，并且不会增加 PJI 诊断算法的价值。
证据水平
三级回顾性队列分析。
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