Leukocyte Esterase Versus ICM 2018 Criteria in the Diagnosis of Periprosthetic Joint Infection

Chisari, Emanuele; Yacovelli, Steven; Goswami, Karan; Shohat, Noam; Woloszyn, Paul; Parvızı, Javad

doi:10.1016/j.arth.2021.03.006

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…1, and the QUADAS‐2 score criteria revealed that most of the extracted studies had high risks. Excluding brand new markers that only appeared recently and have limited data, 129 records reported diagnostic information of serum markers (serum CRP, ESR, procalcitonin, IL‐6, D‐Dimer, WBC, platelet count [PLT], neutrophil to lymphocyte ratio [NLR], monocyte to lymphocyte ratio [MLR], platelet to lymphocyte ratio [PLR], platelet to mean platelet volume ratio [PVR], FDP [fibrin degradation product] and Fibrinogen), 9–11,24–149 114 studies reported synovial markers (synovial WBC, PMN%, IL‐6, IL‐1β, CRP, TNF‐α, Calprotectin, and leucocyte esterase [LE] and laboratory or lateral‐flow based α‐defensin test),…”

Section: Resultsmentioning

confidence: 99%

“…Final analysis was performed on 215 articles with six additional studies searched manually, as shown in platelet to mean platelet volume ratio [PVR], FDP [fibrin degradation product] and Fibrinogen), [9][10][11] 114 studies reported synovial markers (synovial WBC, PMN%, IL-6, IL-1β, CRP, TNF-α, Calprotectin, and leucocyte esterase [LE] and laboratory or lateral-flow based α-defensin test), 10,29,31,34,36,43,49,51,52,58,59,61,62,64,65,[72][73][74]76,77,[79][80][81][84][85][86][87][88]90,95,97,99,117,118,122,124,125,127,129,132,[135][136][137][138]142,1...…”

Section: Study Selectionmentioning

confidence: 99%

See 1 more Smart Citation

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

Tang

Yuan

et al. 2022

Orthopaedic Surgery

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Objective The current diagnostic criteria for periprosthetic joint infection (PJI) are diverse and controversial, leading to delayed diagnosis. This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage. Methods We searched the MEDLINE and Embase databases for retrospective or prospective studies which reported preoperative‐available assays (serum, synovial, or culture tests) for the diagnosis of chronic PJI among inflammatory arthritis (IA) or non‐IA populations from January 1, 2000 to June 30, 2022. Threshold effective analysis was performed on synovial polymorphonuclear neutrophils (PMN%), synovial white blood cell (WBC), serum C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to find the relevant cut‐offs. Results Two hundred and sixteen studies and information from 45,316 individuals were included in the final analysis. Synovial laboratory‐based α‐defensin and calprotectin had the best comprehensive sensitivity (0.91 [0.86–0.94], 0.95 [0.88–0.98]) and specificity (0.96 [0.94‐0.97], 0.95 [0.89–0.98]) values. According to the threshold effect analysis, the recommended cut‐offs are 70% (sensitivity 0.89 [0.85–0.92], specificity 0.90 [0.87–0.93]), 4100/μL (sensitivity 0.90 [0.87–0.93], specificity 0.97 [0.93–0.98]), 13.5 mg/L (sensitivity 0.84 [0.78–0.89], specificity 0.83 [0.73–0.89]), and 30 mm/h (sensitivity 0.79 [0.74–0.83], specificity 0.78 [0.72–0.83]) for synovial PMN%, synovial WBC, serum CRP, and ESR, respectively, and tests seem to be more reliable among non‐IA patients. Conclusions The laboratory‐based synovial α‐defensin and synovial calprotectin are the two best independent preoperative diagnostic tests for PJI. A cut off of 70% for synovial PMN% and tighter cut‐offs for synovial WBC and serum CRP could have a better diagnostic accuracy for non‐IA patients with chronic PJI.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

Tang

Yuan

et al. 2022

Orthopaedic Surgery

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“…When blood is present, the centrifuge may be utilized to help maintain the reliability and accuracy of the test [ 54 ]. Its overall performance has made it a valuable part of the 2018 ICM criteria [ 24 ].…”

Section: Overviewmentioning

confidence: 99%

Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

Quinlan,

Jennings

2023

Arthroplasty

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Diagnosing chronic periprosthetic joint infection (PJI) requires clinical suspicion in combination with both serological and synovial fluid tests, the results of which are generally applied to validated scoring systems or consensus definitions for PJI. As no single “gold standard” test exists, the diagnosis becomes challenging, especially in the setting of negative cultures or equivocal test results. This review aims to address the workup of chronic PJI and considerations for clinical evaluation to guide treatment. Following aspiration of the joint in question, a multitude of tests has been developed in an attempt to assist with diagnosis, including cell synovial white blood cell count, gram stain, cultures, leukocyte esterase, alpha-defensin, synovial C-reactive protein, multiplex polymerase chain reaction, next-generation sequencing, and interleukins. Each test has advantages and disadvantages and should be used in conjunction with the overall clinical picture to guide further clinical evaluation and treatment in this complex patient population.

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“…Periprosthetic joint infections (PJIs) are among the leading causes of revision prosthetic surgery, accounting for 25% of failed total knee replacement (TKR) and 15% of failed total hip replacement (THR) [ 12 , 30 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

Section: Synovial Fluid Proteome In Osteoarthritismentioning

confidence: 99%

The Usefulness of Synovial Fluid Proteome Analysis in Orthopaedics: Focus on Osteoarthritis and Periprosthetic Joint Infections

Bizzoca

Moretti

Gnoni

et al. 2022

JFMK

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Synovial fluid (SF) is a viscous and mucinous substance produced by the synovium, a specialized connective tissue that lines diarthrodial joints. SF represents a source of disease-related proteins that could be used as potential biomarkers in several articular diseases. Based on these findings the study of SF has been gaining increasing importance, in recent years. This review aims to summarize the usefulness of synovial fluid in orthopaedics research and clinical practice, mainly focusing on osteoarthritis (OA) and periprosthetic joint infections (PJIs). Proteomics of the SF has shown the up-regulation of several components of the classic complement pathway in OA samples, including C1, C2, C3, C4A, C4B, C5, and C4 C4BPA, thus depicting that complement is involved in the pathogenesis of OA. Moreover, proteomics has demonstrated that some pro-inflammatory cytokines, namely IL-6, IL-8, and IL-18, have a role in OA. Several SF proteins have been studied to improve the diagnosis of PJIs, including alpha-defensin (Alpha-D), leukocyte esterase (LE), c-reactive protein (CRP), interleukin-6 (IL-6), calprotectin and presepsin. The limits and potentials of these SF biomarkers will be discussed.

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Leukocyte Esterase Versus ICM 2018 Criteria in the Diagnosis of Periprosthetic Joint Infection

Cited by 8 publications

References 16 publications

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

The Usefulness of Synovial Fluid Proteome Analysis in Orthopaedics: Focus on Osteoarthritis and Periprosthetic Joint Infections

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