Department of Orthopedics and Traumatology, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep, Turkey.
Arch Orthop Trauma Surg. 2024 Dec;144(12):5071-5078. doi: 10.1007/s00402-023-05162-9. Epub 2023 Dec 26.
The accurate and timely diagnosis of periprosthetic joint infection (PJI) is critical for guiding optimal treatment management and success, highlighting the requirement of readily available inexpensive serum biomarkers to increase the diagnostic accuracy for PJI. Many studies have investigated the diagnostic accuracy of neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR). However, there is a lack of existing literature regarding optimal thresholds for acute PJI. The purpose of this study was to reveal the most appropriate cut-off values for MLR and NLR in detecting acute PJI with a gender specific analysis.
Patients were classified as having an acute PJI if they met the International Consensus Meeting (ICM) 2018 modified criteria. Patients who had a negative clinical and diagnostic workup for a PJI and the presence of erythema on the index surgical area were included in the erysipelas group (control group). Data obtained from all patients included age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), procedure type (THA or TKA), serum C-reactive protein (CRP), and blood studies at the admission and culture results were retrieved from the electronic medical record.
ROC curve analysis was used to determine the gender-specific optimal threshold values for CRP, NLR, and MLR. Comparing the sensitivities and specificities of NLR and MLR at the identified best thresholds in males and females, the study found similar sensitivities of NLR in males and females with 0.84 and 0.84, respectively. On the other hand, an MLR of 0.67 or more reported a notably higher specificity in male patients [0.90 (95% CI 0.75-0.96) versus 0.70 (95% CI 0.56-0.80)].
NLR and MLR represent commonly ordered, low-cost, simple, and readily available complete cell count laboratory values and should be used as adjunct tests with reasonable diagnostic accuracy in detecting acute PJIs. Moreover, with its excellent specificity and PPV, MLR could provide valuable insight in diagnosing acute PJI, particularly in male patients.
Level III Retrospective Cohort analysis.
准确、及时地诊断假体周围关节感染（PJI）对于指导最佳治疗管理和成功至关重要，这凸显了需要易于获得的廉价血清生物标志物来提高 PJI 的诊断准确性。许多研究已经调查了中性粒细胞与淋巴细胞比值（NLR）和单核细胞与淋巴细胞比值（MLR）的诊断准确性。然而，目前关于急性 PJI 的最佳阈值的文献很少。本研究的目的是通过性别特异性分析揭示 MLR 和 NLR 检测急性 PJI 的最适截断值。
如果患者符合国际共识会议（ICM）2018 年修订标准，则将其归类为患有急性 PJI。如果患者的临床和诊断检查均为阴性，且索引手术部位有红斑，则将其纳入丹毒组（对照组）。从电子病历中检索所有患者的数据，包括年龄、性别、体重指数（BMI）、Charlson 合并症指数（CCI）、手术类型（THA 或 TKA）、血清 C 反应蛋白（CRP）和入院时的血液检查以及培养结果。
使用 ROC 曲线分析确定 CRP、NLR 和 MLR 的性别特异性最佳阈值。在确定的最佳阈值下比较 NLR 和 MLR 在男性和女性中的敏感性和特异性，发现 NLR 在男性和女性中的敏感性相似，分别为 0.84 和 0.84。另一方面，男性患者的 MLR 为 0.67 或更高时，特异性显著提高[0.90（95%CI 0.75-0.96）与 0.70（95%CI 0.56-0.80）]。
NLR 和 MLR 代表常用的、低成本的、简单的、易于获得的全细胞计数实验室值，应作为辅助检测手段，具有合理的诊断准确性，用于检测急性 PJI。此外，由于其出色的特异性和阳性预测值（PPV），MLR 可以为诊断急性 PJI 提供有价值的见解，尤其是在男性患者中。
III 级回顾性队列分析。
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