Improved diagnostic accuracy with the classification tree method for diagnosing low-grade periprosthetic joint infections by quantitative measurement of synovial fluid alpha-defensin and C-reactive protein

Ettinger, Max; Savov, Peter; Calließ, Tilman; Lichtinghagen, Ralf; Lukasz, Alexander; Omar, Mohamed

doi:10.1007/s00264-019-04338-6

Cited by 15 publications

(10 citation statements)

References 28 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Wang²,

Yang³

et al. 2020

International Orthopaedics (SICOT)

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Purpose The platelet-to-lymphocyte ratio (PLR) has been extensively studied in various diseases. However, the relationship between PLR and hip fracture remains unknown. The aim of this study was to evaluate whether PLR would be an independent prognostic factor in elderly hip fracture patients. Methods Between January 2014 and December 2018, a retrospective cohort study was conducted in a orthopaedic centre, China. A total of 460 hip fracture patients were included. PLR was calculated as the ratio of platelet to lymphocyte counts and divided into high PLR group (≥ 189) and low PLR group (< 189) by using the receiver operating characteristic (ROC) curve. The relationship between PLR and one year all-cause mortality rate was assessed by univariate and multivariate Cox proportional hazard models. Further subgroup analysis stratified by different clinical and biological characteristics was performed to make the results more accurate. Results After a median follow-up of 32.0 months (range, 12.0-75.4), 92 patients (mortality rate: 20.0%) died within one year. PLR was significantly higher in dead patients compared with alive patients (p < 0.05), and high PLR group also had a high mortality rate (32.21% vs. 14.15%, p < 0.001). After multivariate adjustment, high PLR remained an independent predictor for one year all-cause mortality (adjusted hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.02-2.41, p = 0.041). Moreover, advanced age (HR 1.05, 95% CI 1.01-1.08), male (HR 1.62, 95% CI 1.06-2.45), CCI ≥ 2 (HR 2.83, 95% CI 1.64-4.89), conservative treatment (HR 5.94, 95% CI 3.71-9.73), low haemoglobin level (HR 1.02, 95% CI 1.01-1.04), and low albumin level (HR 1.07, 95% CI 1.02-1.13) were independent risk factors for survival. Furthermore, subgroup analysis results were consistent with the main findings in most stratified groups. Conclusion This study highlights that high PLR (≥ 189) is associated with increased one year all-cause mortality in elderly hip fracture patients. As PLR is a simple indicator that can be calculated from the blood routine test, it can be easily performed in usual clinical practice.

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Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Wang²,

Yang³

et al. 2020

International Orthopaedics (SICOT)

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“…Thus, IL-6 is supposed to elevate before CRP. In addition, emerging evidences have shown that IL-6 levels are elevated in late PJI [1,4,17,18]. With the ERAS procedure widely conducted in TKA, inflammation caused by surgical trauma has largely decreased [3,19].…”

Section: Discussionmentioning

confidence: 99%

“…However, the early clinical manifestation of PJI may be nonspecific and is becoming a challenge plague for the joint surgeons all over the world. Serological tests, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Interleukin-6 (IL-6), are the simplest and most routine investigation into a guide for early PJI [1].…”

Section: Introductionmentioning

confidence: 99%

“…Though CRP and IL-6 have been proved to be of high sensitivity but relatively low specificity [1,2]. Both of the two biomarkers have been established as parameters assessing inflammation after TKA [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…As for CRP, it is hard to interpret early PJI because studies have shown that CRP will elevate as long as 3 months after the surgery even in the absence of infection [7]. IL-6, a major endogenous protein mediator of the acute phase inflammation, returns to normal level soon after surgery [1,2,8]. Studies have shown that IL-6 not only elevated because of surgical inflammation [4] but also in late PJI.…”

Section: Introductionmentioning

confidence: 99%

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Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario

Huang¹,

Huang²,

Wang³

et al. 2020

BMC Musculoskelet Disord

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Background: We designed the current study to understand the normal trajectories of interleukin-6 (IL-6) and Creactive protein (CRP) in the immediate hours and days after primary total knee arthroplasty (TKA) under the management of an enhanced recovery after surgery (ERAS) protocol and examined whether one or the other returned to normal more quickly. Methods: In this prospective cross-sectional study, we examined the plasma IL-6 and CRP levels in 100 patients undergoing primary TKA at the following time points: 12 h preoperatively as well as postoperatively 12 h, 48 h, 3 days and 2 weeks. Patients were followed up for 1 year to monitor the postoperative complications, especially the infection. Results: IL-6 peaked at 48 h postoperatively. Then IL-6 started to decline at 3 days postoperatively and went back to baseline level at 2 weeks (p = 0.950). CRP peaked at 3 days postoperatively. At 2 weeks, CRP declined to a normal range, without being significantly different from the baseline level (p = 0.816). Conclusion: We found that under the ERAS scenario, the postoperative peak of IL-6 and CRP was deferred compared with previous studies. Compared to IL-6, CRP showed a gradual rise after surgery. Both of these two biomarkers returned to normal under the ERAS scenario. Future multiple-center studies with larger sample size can help define the thresholds of IL-6 and CRP for periprosthetic joint infection (PJI) early diagnosis. With these reference data, a clinician can make a quicker decision to perform aspiration to diagnose early PJI and benefits more patients.

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Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes

Fusini

Aprato

Massè

et al. 2019

International Orthopaedics (SICOT)

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Improved diagnostic accuracy with the classification tree method for diagnosing low-grade periprosthetic joint infections by quantitative measurement of synovial fluid alpha-defensin and C-reactive protein

Cited by 15 publications

References 28 publications

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

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

Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario

Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes

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