Serum procalcitonin, interleukin-6, soluble intercellular adhesin molecule-1 and IgG to shortchain exocellular lipoteichoic acid as predictors of infection in total joint prosthesis revision

Abstract

The diagnosis of prosthetic joint infection and its differentiation from aseptic loosening remains problematic. The definitive laboratory diagnostic test is the recovery of identical infectious agents from multiple intraoperative tissue samples; however, interpretation of positive cultures is often complex as infection is frequently associated with low numbers of commensal microorganisms, in particular the coagulase-negative staphylococci (CNS). In this investigation, the value of serum procalcitonin (PCT), interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) as predictors of infection in revision hip replacement surgery is assessed. Furthermore, the diagnostic value of serum IgG to short-chain exocellular lipoteichoic acid (sce-LTA) is assessed in patients with infection due to CNS. Presurgical levels of conventional serum markers of infection including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) is also established. Forty-six patients undergoing revision hip surgery were recruited with a presumptive clinical diagnosis of either septic (16 patients) or aseptic loosening (30 patients). The diagnosis was confirmed microbiologically and levels of serum markers were determined. Serum levels of IL-6 and sICAM-1 were significantly raised in patients with septic loosening (P = 0.001 and P = 0.0002, respectively). Serum IgG to sce-LTA was elevated in three out of four patients with infection due to CNS. In contrast, PCT was not found to be of value in differentiating septic and aseptic loosening. Furthermore, CRP, ESR and WBC were significantly higher (P = 0.0001, P = 0.0001 and P = 0.003, respectively) in patients with septic loosening. Serum levels of IL-6, sICAM-1 and IgG to sce-LTA may provide additional information to facilitate the diagnosis of prosthetic joint infection.

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

“…Others have found sensitivity and specificity values for procalcitonin in similar ranges (Table 3) [2,5,11,14,21,26,29,30,33]. However, the results reported by Worthington et al were quite different: serum procalcitonin did not help distinguish between infectious and noninfectious causes of prosthetic hip loosening [41].…”

“…Wirtz et al [40] found IL-6 concentration correlates with a high degree of inflammatory activity, with a more rapid increase and quicker return to normal values than CRP, suggesting IL-6 measurements give a better indication of postoperative inflammatory response than CRP measurements after TKA and THA. Worthington et al [41] reported CRP and leukocyte level were significantly higher in patients with septic loosening of a hip prosthesis, IL-6 was seen only as additional information, and serum procalcitonin did not help in distinguishing infectious from noninfectious causes.…”

“…IL-6 has been reported to be a sensitive marker for bacterial infection after total joint arthroplasty [4,40,41]. As IL-6 triggers the release of CRP in liver cells, it reacts much faster to infection than CRP [38,40].…”

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

“…6,7 Early diagnosis of a postoperative infectious complication is essential for timely and adequate treatment of this condition. However, some subsequent studies have shown opposite results, 10,18 and the prognostic and/or diagnostic value of this parameter still remains controversial. In the absence of relative study, we addressed this issue by conducting a prospective observational cohort study to determine the role of PCT in predicting postoperative infectious complication in spinal cord injury patients.…”

“…[6][7][8] Nevertheless, in current clinical practice, PCT are not widely used as routine screening tests in the early postoperative period, with most surgeons relying on the leukocyte count, CRP and ESR despite evidence that these are poor diagnostic tests. 9 PCT was already used in several other studies to predict postoperative infections after several different operations, [5][6][7][8]10,11 however, the predictive value of serum PCT in detecting postoperative infectious complications in spinal cord injury patients has not been studied.…”