Zhang Xiaohui, Lu Fan, Zhang Baolin, Liu Zhongcheng, Geng Bin, Han Hua, Xia Yayi
Department of Orthopaedic Surgery, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, Gansu Province, China.
J Arthroplasty. 2025 Nov;40(11):2984-2989. doi: 10.1016/j.arth.2025.04.086. Epub 2025 May 7.
Inflammatory biomarkers serve as the first-line screening tools for diagnosing periprosthetic joint infection (PJI). However, the kinetics and trajectory of each biomarker in response to inflammatory stimuli vary. This study aimed to identify the most reliable diagnostic predictors for acute and chronic PJI through a comprehensive evaluation of the diagnostic accuracy of commonly utilized serum biomarkers.
We retrospectively analyzed 282 patients undergoing revision total hip or knee arthroplasty between January 2016 and October 2022. After exclusions, 218 patients were categorized into acute PJI (n = 46), chronic PJI (n = 62), and non-PJI (n = 110) groups. A PJI diagnosis was established according to the 2013 International Consensus Meeting criteria. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic value of serum biomarkers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), plasma fibrinogen (FIB), and platelet count (PLT).
The IL-6 demonstrated the highest diagnostic accuracy for acute PJI, with an area under the curve of 0.929, followed by CRP (0.853), ESR (0.816), FIB (0.788), and PLT (0.683). In contrast, CRP showed the highest diagnostic accuracy for chronic PJI, with an area under the curve of 0.908, followed by IL-6 (0.899), FIB (0.883), ESR (0.850), and PLT (0.770). For acute PJI diagnosis, the optimal cut-off value for IL-6 was determined to be 7.2 pg/mL, demonstrating a sensitivity of 93.5%, specificity of 83.6%, positive predictive value of 70.5%, and negative predictive value of 96.8%. For chronic PJI diagnosis, the optimal cut-off value for CRP was 15.1 mg/L, yielding a sensitivity of 77.4%, specificity of 91.8%, positive predictive value of 84.2%, and negative predictive value of 87.8%.
Serum IL-6 and CRP exhibit excellent diagnostic performance for acute and chronic PJI, respectively. Pairing comparison reveals that IL-6 represents the most accurate biomarker for diagnosing acute PJI.
炎症生物标志物是诊断人工关节周围感染（PJI）的一线筛查工具。然而，每种生物标志物对炎症刺激的反应动力学和变化轨迹各不相同。本研究旨在通过全面评估常用血清生物标志物的诊断准确性，确定急性和慢性PJI最可靠的诊断预测指标。
我们回顾性分析了2016年1月至2022年10月期间接受翻修全髋关节或膝关节置换术的282例患者。排除相关病例后，将218例患者分为急性PJI组（n = 46）、慢性PJI组（n = 62）和非PJI组（n = 110）。根据2013年国际共识会议标准确立PJI诊断。采用受试者工作特征曲线分析来评估血清生物标志物的诊断价值，这些生物标志物包括C反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞介素-6（IL-6）、血浆纤维蛋白原（FIB）和血小板计数（PLT）。
IL-6对急性PJI的诊断准确性最高，曲线下面积为0.929，其次是CRP（0.853）、ESR（0.816）、FIB（0.788）和PLT（0.683）。相比之下，CRP对慢性PJI的诊断准确性最高，曲线下面积为0.908，其次是IL-6（0.899）、FIB（0.883）、ESR（0.850）和PLT（0.770）。对于急性PJI诊断，IL-6的最佳截断值确定为7.2 pg/mL，敏感性为93.5%，特异性为83.6%，阳性预测值为70.5%，阴性预测值为96.8%。对于慢性PJI诊断，CRP的最佳截断值为15.1 mg/L，敏感性为77.4%，特异性为91.8%，阳性预测值为84.2%，阴性预测值为87.8%。
血清IL-6和CRP分别对急性和慢性PJI具有出色的诊断性能。配对比较显示，IL-6是诊断急性PJI最准确的生物标志物。
