Combined serum biomarker analysis shows no benefit in the diagnosis of periprosthetic joint infection

Abstract

Purpose In many cases, the diagnosis of a periprosthetic joint infection (PJI) consisting of the clinical appearance, laboratory tests, and other diagnostic tools remains a difficult task. Single serum biomarkers are easy to collect, are suitable for periodical assessment, and are a crucial tool in PJI diagnosis, but limited sensitivity or specificity is reported in literature. The aim of this study was to combine the best-performing single serum biomarkers into a multi-biomarker model aiming to improve the diagnostic properties. Methods Within a 27-month period, 124 surgical procedures (aseptic or septic revision total knee arthroplasty (TKA) or total hip arthroplasty (THA)) were prospectively included. The serum leukocyte count, C-reactive protein (CRP), interleukin-6, procalcitonin, interferon alpha, and fibrinogen were assessed 1 day prior to surgery. Logistic regression with lasso-regularization was used for the biomarkers and all their ratios. After randomly splitting the data into a training (75%) and a test set (25%), the multi-biomarker model was calculated and validated in a cross-validation approach. Results CRP (AUC 0.91, specificity 0.67, sensitivity 0.90, p value 0.03) and fibrinogen (AUC 0.93, specificity 0.73, sensitivity 0.94, p value 0.02) had the best single-biomarker performances. The multi-biomarker model including fibrinogen, CRP, the ratio of fibrinogen to CRP, and the ratio of serum thrombocytes to CRP showed a similar performance (AUC 0.95, specificity 0.91, sensitivity 0.72, p value 0.01). Conclusion In this study, multiple biomarkers were tested for their diagnostic performance, with CRP and fibrinogen showing the best results regarding the AUC, accuracy, sensitivity, and specificity. It was not possible to further increase the diagnostic accuracy by combining multiple biomarkers using sophisticated statistical methods.

High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture

“…Systemic inflammation is associated with many orthopaedic diseases, such as periprosthetic joint infection [20,21], and surgical site infection [22,23]. PLR is a simple inflammatory marker that does not need any additional laboratory testing, and easily calculated by the platelet count/lymphocyte count formula.…”

Reliability of circulating fibrinogen in the diagnosis of prosthesis-related infections: a systematic review and meta-analysis

“…Five studies were rejected for several reasons, such as irrelevant research (n = 1), duplicate research (n = 1), commentary (n = 2), or review (n = 1). Finally, 7 references were included in this study [17,18,[21][22][23][24][25]. The details of the study selection process can be found in Fig.…”

“…However, the patient selection and reference standard were both high risk, because 6 studies did not avoid case-control designs and interpretations of reference standards were not blinded [17,18,[21][22][23]25]. In addition, the thresholds of FIB for the 7 studies were not pre-specified; therefore, all index texts were high risk [17,18,[21][22][23][24][25].…”

“…Six retrospective [17,18,[21][22][23]25] and one prospective [24] case-control studies, including 1341 patients, were finally selected. All studies were single-center [17,18,[22][23][24][25] except for one multicenter study [21]. Among the 7 studies, 6 were from China [17,18,[21][22][23]25] and 1 from the USA [24].…”

“…All studies were single-center [17,18,[22][23][24][25] except for one multicenter study [21]. Among the 7 studies, 6 were from China [17,18,[21][22][23]25] and 1 from the USA [24]. All 7 studies, including PJI involving knee or hip joints, were published in the past 2 years.…”