Plasma fibrinogen in the diagnosis of periprosthetic joint infection

Abstract

Periprosthetic joint infections (PJIs) have become the most catastrophic complication for patients after arthroplasty. Although previous studies have found that many biomarkers have good performance for diagnosing PJI, early diagnosis remains challenging and a gold standard is lacking. This study aimed to investigate the diagnostic accuracy of plasma fibrinogen (FIB) in detecting PJI compared to other traditional biomarks (CRP, WBC and ESR). A total of 156 patients (including 57 PJI and 99 non-PJI patients) who underwent revision arthroplasty were retrospectively reviewed from 01/2014 to 01/2020. The diagnostic criteria of PJI were mainly based on the definition from the evidence-based definition for periprosthetic joint infection in 2018. The optimal plasma FIB predictive cutoff was 4.20 g/L, the sensitivity of the plasma fibrinogen was 0.860, the specificity was 0.900, the positive predictive value (PPV) was 0.831, and the negative predictive value (NPV) was 0.908. The area under the curve (AUC) value of plasma fibrinogen was 0.916 (95% CI 0.869–0.964), and the CRP, ESR and WBC levels had AUCs of 0.901, 0.822 and 0.647, respectively. Plasma FIB demonstrated better diagnostic strength compared with that of other serum biomarkers before revision arthroplasty. It represents a new horizon for the diagnosis of PJI due to the diagnosis values and cost-effective features.

Serum Inflammatory Biomarkers in the Diagnosis of Periprosthetic Joint Infections

“…In knees (septic: 13.5 G/L, aseptic 7.9 G/L) and in hips (septic: 11.6 G/L, aseptic: 7.6 G/L), a higher mean was shown in septic compared with aseptic cases ( p = 0.001 and p = 0.0003, respectively). Yang et al [ 29 ] also reported in a cohort of 156 patients, including 57 PJIs and 99 non-PJIs, a difference between both groups regarding serum WBC (PJI: 7.8 G/L; non-PJI: 6.4 G/L; p < 0.001). In our study [ 2 ], the mean WBC in septic cases ( n = 75) was 8.8 G/L and in aseptic patients ( n = 102), it was 7.0 G/L ( p < 0.0001).…”

“…Lower cut-off values were described by Glehr et al [13] (cut-off: 5.48 G/L) and Klim et al [20] (cut-off 5.68), leading to a higher sensitivity (91% and 90%, respectively) but at the expense of specificity (34% and 39%, respectively). Table 3 shows the recent literature of WBC depending on the used infection definition [2,10,11,13,[15][16][17]20,23,25,29,35].…”

“…In the literature, a broad range of sensitivities from 62% to 100%, and specificities from 64% to 96% [ 2 , 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] were described. Table 1 shows the results of the recent literature of serum CRP depending on the used infection definition.…”

“…Nevertheless, the AAOS and the MSIS again endorse the use of ESR to aid in preoperative diagnosis of PJI [ 1 , 9 ], while the EBJIS does not include it in their infection definition due to their low accuracy. In the literature, sensitivities ranged from 33% to 95%, and specificities from 60% to 100% [ 6 , 10 , 11 , 12 , 14 , 15 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 42 ]. Table 2 shows the recent literature of ESR depending on the used infection definition.…”

“…On the other hand, some studies found that the WBC values are significantly higher in patients with PJI compared with aseptic failure cases [ 13 , 15 , 17 , 20 , 23 , 29 , 35 , 50 ]. Toossi et al [ 35 ] observed a mean WBC of 9236 cells/µL (95% CI 8896–9575 cells/µL) in infected cases and 7331 cells/µL (7204–7458 cells/µL) ( p < 0.001) in noninfected cases.…”