Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis

Abstract

BackgroundSynovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI.MethodsWe conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis.ResultsAfter full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84–90%), 96% (95% CI 95–97%), and 170.09 (95% CI 97.63–296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83–90%), 97% (95% CI 96–98%), and 158.18 (95% CI 74.26–336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively.ConclusionBoth LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…The second assay is the lateral flow device, which rapidly detects infection within 20 minutes without the need for a laboratory. Accordingly, pooled results supported the higher sensitivity of the synovial fluid alpha-defensin ELISA compared to the lateral flow test [19][20][21][22]. The current meta-analysis demonstrated synovial fluid alpha-defensin to have the highest sensitivity in the diagnosis of PJI.…”

“…Embase was the most described database (101), followed by MEDLINE (80), and Cochrane (74; Table 9). Three databases were most frequently searched (40), followed by four (22), and five (16). The most combined database group was Cochrane Library + Embase + MEDLINE/PubMed (10), followed by Embase + MEDLINE (6), and Cochrane Library + Embase + MEDLINE + Web of Science (5).…”

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…One assay is the enzyme-linked immunosorbent assay (ELISA), which is performed in a laboratory with results obtained within 24 h. The second assay is the lateral flow device, which rapidly detects infection within 20 min without the need for a laboratory. Accordingly, pooled results supported the higher sensitivity of the synovial fluid alpha-defensin ELISA compared to the lateral flow test [16,20,23,27] Sonicate fluid and periprosthetic tissue were performed most intraoperatively, whereas tissue PCR and sonicate fluid BCB were the most sensitive tests in tissue and sonicate fluid, respectively. In 2013, Qu et al [37] performed the first meta-analysis of PCR in the diagnosis of PJI.…”

“…The number of authors of a single article ranged from 2 to 37. The largest number of collaborating authors was four (27), followed by six (25) and 5 authors (20; Table 3). The author with most first authorships was Setor K. Kunutsor (10), followed by Xinhua Qu (3).…”

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…Interestingly, the most popular diagnostic test applied in recent years was synovial fluid alpha-defensin, which also had the highest sensitivity. Accordingly, pooled results supported the higher sensitivity of the synovial fluid alpha-defensin immunoassay compared to the lateral flow test[14][15][16][17]. Preoperative tests with the lowest sensitivities were synovial fluid gram staining (GS), synovial fluid procalcitonin (PCT), serum white blood cells (WBCs), serum PCT, which were all found to have a sensitivity of less than 60%.…”