Combination of C-reactive protein and fibrinogen is useful for diagnosing periprosthetic joint infection in patients with inflammatory diseases

Background The diagnosis of periprosthetic joint infection (PJI) remains challenging. Currently, there is no single test marker for PJI that has an acceptable level of sensitivity. To enhance diagnostic accuracy, ratio or combined tests have been introduced. Blood testing is crucial as the first step in clinical testing, so this article aims to improve diagnostic efficiency by combining blood test markers. Methods༚ We conducted a retrospective data collection of 288 patients who underwent total hip or knee joint revision surgery in our hospital from January 2013 to January 2023. A total of 227 patients who met the inclusion criteria were divided into two groups: PJI group (89 cases) and aseptic loosening group (138 cases). Blood test indicators were collected preoperatively as diagnostic indicators for PJI. New diagnostic parameters were formed by combining the indicators through ratios. The diagnostic value of all biomarkers was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC), and the optimal cutoff value, positive predictive value (PPV), and negative predictive value (NPV) were further calculated using the Youden index. Results༚ The PJI group showed significantly higher levels of ESR, CRP, PLT, CLR, ELR, PMR, PLR, SII, and CRP/ALB compared to the aseptic loosening group. The diagnostic performance of serum ratio biomarkers including CRP/WBC, CLR, CRP/FIB, CRP/ALB, CRP/GLB, and CRP/AGR were all above 0.900, with AUCs of 0.902, 0.913, 0.900, 0.908, 0.915, and 0.915, respectively, indicating excellent diagnostic value. CRP/ALB and CRP/AGR had higher diagnostic performance than traditional serum biomarkers ESR (AUC = 0.840) and CRP (AUC = 0.913), with sensitivities of 80.9% and 88.8%, and specificities of 89.9% and 83.3%, respectively. Conclusion Compared with traditional markers ESR and CRP, the new ratio combination significantly improved the accuracy and reliability of PJI diagnosis (P < 0.001), among which CRP/ALB and CRP/AGR have good discriminative ability.

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C-Reactive Protein-to-Albumin Ratio (CAR) and C-Reactive Protein-to-Lymphocyte Ratio (CLR) are Valuable Inflammatory Biomarker Combination for the Accurate Prediction of Periprosthetic Joint Infection

Shi¹,

Jiang²,

Tian³

et al. 2023

IDR

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Background Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty (TJA). Timely and accurate diagnosis is important for the management of PJI. Currently, many biomarkers are available for the diagnosis of PJI, but which inflammatory biomarker combination has the best diagnostic value has not been reported. Materials and Methods We retrospectively analyzed 244 patients who underwent revision knee or hip arthroplasty in our institution. They were divided into two groups: 87 in the PJI group and 157 in the aseptic failure (AF) group. The preoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP-to-albumin ratio (CAR), CRP-to-lymphocyte ratio (CLR), neutrophil-to-albumin ratio (NAR) and platelet-to-albumin ratio (PAR) were determined and compared between the two groups. Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the diagnostic value of all biomarkers, and the optimal cut-off value, positive predictive value (PPV) and negative predictive value (NPV) were further calculated by the Youden index. Results The NLR, PLR, CAR, CLR, NAR and PAR of the PJI group were significantly higher than those of the AF group ( P <0.001). According to the ROC and AUC results, the diagnostic value of CAR and CLR was considered excellent with AUCs of 0.931 and 0.935, respectively. The diagnostic value of NAR (0.739) and PAR (0.785) were fair, the diagnostic value of NLR (0.694) was poor, and PLR (0.535) had no diagnostic ability. Subgroup analysis showed no significant differences in combined inflammatory biomarkers between the two groups. Conclusion CAR and CLR are valuable combined inflammatory biomarkers for diagnosing PJI, while other markers were of limited value for the diagnosis of PJI.

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Combination of C-reactive protein and fibrinogen is useful for diagnosing periprosthetic joint infection in patients with inflammatory diseases

Cited by 3 publications

References 34 publications

Diagnostic and Predictive Efficacy of Synovial Fluid Versus Serum C-Reactive Protein Levels for Periprosthetic Joint Infection and Reimplantation Success

Diagnostic and Predictive Efficacy of Synovial Fluid Versus Serum C-Reactive Protein Levels for Periprosthetic Joint Infection and Reimplantation Success

The diagnostic value of ratio biomarkers for periprosthetic joint infection

C-Reactive Protein-to-Albumin Ratio (CAR) and C-Reactive Protein-to-Lymphocyte Ratio (CLR) are Valuable Inflammatory Biomarker Combination for the Accurate Prediction of Periprosthetic Joint Infection

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