Park Hyung Jun, Jeon Ji Hoon, Song Juhyun, Seok Hyeri, Choi Hee Kyoung, Choi Won Suk, Choi Sungjae, Nam Myung-Hyun, Suh Dong Hun, Kim Jae Gyoon, Park Dae Won
Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
J Clin Med. 2025 Aug 1;14(15):5415. doi: 10.3390/jcm14155415.
Septic arthritis is an orthopedic emergency. However, optimal biomarkers and diagnostic criteria remain unclear. The study aimed to evaluate the diagnostic performance of routinely used and novel biomarkers, including serum C-reactive protein (CRP), synovial white blood cells (WBC), pentraxin-3 (PTX3), interleukin-6 (IL-6), and presepsin, in distinguishing septic from non-septic arthritis. Thirty-one patients undergoing arthrocentesis were included. Patients were categorized into septic and non-septic arthritis groups. Synovial fluid and serum samples were analyzed for five biomarkers. Diagnostic performance was assessed by calculating the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Synovial WBC demonstrated the highest diagnostic performance among single biomarkers (AUC = 0.837, = 0.012). Among novel biomarkers, PTX3 showed the highest accuracy and sensitivity. The serum CRP and synovial WBC combination yielded an AUC of 0.853, with 100% sensitivity, 68.0% specificity, 42.9% PPV, and 100% NPV. Adding all three novel biomarkers to this combination increased the AUC to 0.887 ( = 0.004), maintaining 100% sensitivity and NPV. When individually added, PTX3 achieved 100% sensitivity and NPV, while presepsin showed the highest specificity (96.0%), PPV (75.0%), and accuracy (87.1%). Serum CRP and synovial WBC remain essential biomarkers for diagnosing septic arthritis; however, combining them with PTX3, IL-6, and presepsin improved diagnostic accuracy. PTX3 is best suited for ruling out septic arthritis due to its high sensitivity and NPV, whereas presepsin is more useful for confirmation, given its specificity and PPV. These results support a tailored biomarker approach aligned with diagnostic intent.
化脓性关节炎是一种骨科急症。然而，最佳的生物标志物和诊断标准仍不明确。该研究旨在评估常规使用的和新型生物标志物，包括血清C反应蛋白（CRP）、滑膜白细胞（WBC）、五聚素3（PTX3）、白细胞介素-6（IL-6）和降钙素原，在区分化脓性关节炎和非化脓性关节炎方面的诊断性能。纳入了31例接受关节穿刺术的患者。患者被分为化脓性关节炎组和非化脓性关节炎组。对滑液和血清样本进行了五种生物标志物的分析。通过计算曲线下面积（AUC）、准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）来评估诊断性能。滑膜白细胞在单一生物标志物中表现出最高的诊断性能（AUC = 0.837，P = 0.012）。在新型生物标志物中，PTX3显示出最高的准确性和敏感性。血清CRP和滑膜白细胞的组合产生的AUC为0.853，敏感性为100%，特异性为68.0%，PPV为42.9%，NPV为100%。将所有三种新型生物标志物添加到该组合中可将AUC提高到0.887（P = 0.004），同时保持100%的敏感性和NPV。单独添加时，PTX3达到100%的敏感性和NPV，而降钙素原显示出最高的特异性（96.0%）、PPV（75.0%）和准确性（87.1%）。血清CRP和滑膜白细胞仍然是诊断化脓性关节炎的重要生物标志物；然而，将它们与PTX3、IL-6和降钙素原结合可提高诊断准确性。PTX3因其高敏感性和NPV最适合排除化脓性关节炎，而降钙素原因其特异性和PPV更有助于确诊。这些结果支持一种与诊断意图相一致的个性化生物标志物方法。
