University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Orthopädische Chirurgie München, Steinerstr. 6, 81369, München, Germany.
Int Orthop. 2024 Sep;48(9):2421-2427. doi: 10.1007/s00264-024-06255-9. Epub 2024 Jul 20.
Searching for quick determinable biomarkers with high sensitivity and specificity is necessary to improve and optimise the early diagnosis of periprosthetic elbow infection (PEI). Therefore, this study's objective was to evaluate the diagnostic value of synovial fluid interleukin-6 (IL-6) levels for diagnosing PEI in total elbow arthroplasty.
Twelve prospective enrolled patients underwent total elbow arthroplasty revision surgery, during which synovial fluid was obtained. Between the initial implantation and the revision procedure were 33.5 ± 41 months (range, 2-144 months). Synovial fluid was collected for immediate IL-6 analysis parallel to the revision surgery. Furthermore, microbiological samples were obtained and analysed. Two groups were defined based on the microbiological results: non-infection and infection group. The ability of synovial fluid IL-6 analysis to predict infection status was explored using receiver operating characteristic curves and further statistical analysis.
Synovial fluid IL-6 analysis had a good diagnostic accuracy of 83% for PEI with an area under the curve of 0,79 and an ideal cutoff value (determined using Youden's criterion) of 15244 pg/mL.
This is the first study to clinically evaluate IL-6 as a diagnostical marker for periprosthetic joint infection (PJI) in total elbow arthroplasty. Our results suggest a good accuracy and high sensitivity for IL-6 to identify a PEI. The analysis of IL-6 can improve surgical decision-making regarding managing total elbow arthroplasty in terms of one- or two-staged revision.
IL-6 can play an important role in the perioperative differentiation of infected and non-infected situations.
寻找具有高灵敏度和特异性的快速可确定生物标志物对于改善和优化人工肘关节周围感染（PEI）的早期诊断是必要的。因此，本研究旨在评估关节液白细胞介素-6（IL-6）水平对全肘关节置换术后 PEI 的诊断价值。
12 例前瞻性纳入的患者接受了全肘关节翻修手术，在此期间采集了滑膜液。初次植入与翻修手术之间的时间为 33.5±41 个月（范围，2-144 个月）。在翻修手术的同时立即进行滑膜液 IL-6 分析，并采集微生物样本进行分析。根据微生物学结果将两组定义为：感染组和非感染组。使用受试者工作特征曲线和进一步的统计分析探讨滑膜液 IL-6 分析对感染状态的预测能力。
滑膜液 IL-6 分析对 PEI 的诊断准确性较高，为 83%，曲线下面积为 0.79，理想的截断值（使用约登指数确定）为 15244pg/ml。
这是第一项临床评估白细胞介素-6 作为全肘关节置换术后人工关节周围感染（PJI）诊断标志物的研究。我们的结果表明，IL-6 具有良好的准确性和高灵敏度，可用于识别 PEI。分析 IL-6 可以改善全肘关节置换术的手术决策，包括一期或二期翻修。
IL-6 在围手术期区分感染和非感染情况方面可能发挥重要作用。
