General Assembly, Diagnosis, Laboratory Test: Proceedings of International Consensus on Orthopedic Infections

Barrack, Robert L.; Bhimani, Samrath; Blevins, Jason L.; Blevins, Kier; Demetres, Michelle; Figgie, Mark P.; Fillingham, Yale A.; Goodman, Susan M.; Huddleston, James I.; Kahlenberg, Cynthia A.; Lautenbach, Charles; Lin, Jianhao; Lonner, Jess H.; Lynch, Maureen; Malkani, Arthur L.; Martin, Lily; Mirza, Serene; Najjad, Muhammad Kazim Rahim; Penna, Sreeram; Richardson, Shawn S.; Sculco, Peter K.; Shahi, Alisina; Szymonifka, Jackie; Wang, Qiaojie

doi:10.1016/j.arth.2018.09.070

Cited by 24 publications

(14 citation statements)

References 105 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[21]. According to the conflicting results reported, no clear recommendation on the usefulness can be made [22]. A trend can be seen towards increased specificity with reduced sensitivity when comparing the mentioned results with our own multi-biomarker findings.…”

Section: Discussionmentioning

confidence: 84%

“…Bottner et al reported high sensitivity and specificity for PJI detection both for CRP (95 and 96%) and IL-6 (95 and 87%) while their combination lead to a sensitivity of 100% and a specificity of 86% [ 21 ]. According to the conflicting results reported, no clear recommendation on the usefulness can be made [ 22 ]. A trend can be seen towards increased specificity with reduced sensitivity when comparing the mentioned results with our own multi-biomarker findings.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Klim

Amerstorfer

Glehr

et al. 2020

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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

Klim

Amerstorfer

Glehr

et al. 2020

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Although it is traditionally considered a laboratory inflammation indicator, the process of erythrocyte sedimentation is influenced by other numerous physiological and pathophysiological factors, most significant being anemia, alterations in RBC morphology, and presence of paraproteins, thus limiting its utility in inflammatory conditions . With the introduction of more specific inflammatory biomarkers, its usefulness has decreased and nowadays ESR remains helpful in the diagnosis and monitoring of a limited number of clinical conditions, in particular rheumatoid diseases, orthopedic infections, and Hodgkin's lymphoma …”

Section: Introductionmentioning

confidence: 99%

“…is influenced by other numerous physiological and pathophysiological factors, most significant being anemia, alterations in RBC morphology, and presence of paraproteins, thus limiting its utility in inflammatory conditions. 5 With the introduction of more specific inflammatory biomarkers, its usefulness has decreased and nowadays ESR remains helpful in the diagnosis and monitoring of a limited number of clinical conditions, in particular rheumatoid diseases, 8 orthopedic infections, 9 and Hodgkin's lymphoma. 10 The International Council for Standardization in Haematology (ICSH) defines the Westergren method originally introduced in 1921 as the gold standard method for ESR determination.…”

mentioning

confidence: 99%

Analytical validation of the iSED automated analyzer for erythrocyte sedimentation rate

Lapić

Miloš

Tosato

et al. 2019

Int J Lab Hematology

View full text Add to dashboard Cite

Introduction iSED is an alternate automated analyzer for erythrocyte sedimentation rate (ESR) based on photometric rheology technology that estimates ESR by measuring rouleaux formation. The aim was to evaluate the analytical performance of the iSED analyzer and compare the results with the Westergren method and another alternate ESR analyzer, TEST1. Methods Validation was performed at two study sites according to the recommendations by the International Council for Standardization in Haematology and included determination of intrarun precision and inter‐run precision, bias, carryover, and method comparison, which was further assessed for samples with normal and low hematocrit, as well as per low, middle, and upper third of the analytical range. Results Intrarun coefficients of variation (CVs) with commercial controls were 4.0% and 1.8%, while inter‐run CVs 7.5% and 0.7%, for the normal and pathological range, respectively. Intrarun CVs obtained with patient samples were 19.9%, 9.9%, 10.3%, and 9.4%, the highest being for the lowest ESR value. Correlation coefficients for the comparison between iSED and Westergren were 0.862 (Site‐1) and 0.916 (Site‐2). While proportional difference with a positive bias was revealed at Site‐1, comparison at Site‐2 showed both constant and proportional difference and a negligible negative bias. Higher correlation was obtained for samples with low than normal hematocrit. Comparison between iSED and TEST1 yielded a correlation coefficient of 0.986, constant and proportional difference, and positive bias. Carryover was 3.2%. Conclusion This study proved the analytical validity of the iSED analyzer, despite minor discrepancies to the Westergren method that can be attributed to methodological differences.

show abstract

“…Thus, to date, ongoing investigations are focused on the establishment of appropriate methods for prompt and precise diagnosis of PJIs. Despite the wide range of available diagnostic tests, diagnostic performance varies, and no adequate sensitivity and sensibility have been achieved 6,7 . In an effort to establish a standard and effective diagnostic algorithm for patients suspected of PJI, the Musculoskeletal Infection Society (MSIS) recommended a panel of clinical and laboratory parameters, 8 modified in 2013 by the International Consensus Meeting (ICM), 9 to standardize the classification of PJIs.…”

Section: Introductionmentioning

confidence: 99%

Detection of α‐defensin in synovial fluids by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry as an innovative and cost‐effective assay for improved definition of periprosthetic joint infections

Petrucca

Santino

Gentile

et al. 2020

Rapid Comm Mass Spectrometry

View full text Add to dashboard Cite

Rationale:Detection of α-defensins in synovial fluid is gaining more and more interest in the field of correct diagnosis of periprosthetic joint infections (PJIs). At present, they can be assessed by a quantitative enzyme-linked immunosorbent assay which is expensive and time-consuming and by a qualitative lateral flow immunoassay which is rapid but quite expensive and whose clinical sensitivity is debated. Thus, developing an alternative rapid, accurate, and low-cost assay for α-defensins is important to make α-defensins actionable as novel key clinical markers. Methods: Synovial fluid (SF) samples were obtained from 18 patients undergoing revision of primary joint arthroplasty. Of these, eight met the 2013 Musculoskeletal Infection Society (MSIS) criteria for PJIs, the remaining were classified as aseptic failure. Microbiological analysis and Synovasure assays were carried out on all samples. Sample preparation and the matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) settings were adjusted to detect human neutrophil peptide (HNP)-1, -2 and -3 and to obtain optimal results in term of sensitivity and stability. Results: MALDI-TOF MS was able to detect HNPs in SF from septic patients. No signals for HNPs were detected in SF from aseptic failure. The limits of detection (LOD) were 2.5 and 1.25 μg/mL for HNP-2 and HNP-1, respectively. The turnaround time of the analysis is 20 min, and SF samples are stable at −20 C for up to 3 days.Assay sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 100% for all parameters. On the same SF samples, the Synovasure assay showed lower sensitivity specificity, and PPV and NPV of 87.5%, 90%, 87.5% and 90%, respectively. Microbiological analysis of SF confirmed the presence of bacteria only in SF MSIS-positive patients. Conclusions:The reported MALDI-TOF MS assay was able to detect and differentiate HNPs in SF samples and showed a slightly better diagnostic accuracy than the Synovasure assay.

show abstract

General Assembly, Diagnosis, Laboratory Test: Proceedings of International Consensus on Orthopedic Infections

Cited by 24 publications

References 105 publications

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

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

Analytical validation of the iSED automated analyzer for erythrocyte sedimentation rate

Detection of α‐defensin in synovial fluids by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry as an innovative and cost‐effective assay for improved definition of periprosthetic joint infections

Contact Info

Product

Resources

About