Synovial calprotectin for the diagnosis of periprosthetic joint infection: a diagnostic meta-analysis

Abstract

Background Periprosthetic joint infections (PJI) are a rare but severe complication of total joint arthroplasty (TJA). However, the diagnosis of PJI remains difficult. It is one of the research that focuses about diagnosis for PJI for majority researchers to discover a novel biomarker. This meta-analysis tried to evaluate diagnostic value of synovial calprotectin for PJI. Methods This meta-analysis search of the literature was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. Literature quality was appraised using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) based on RevMan (version 5.3). The diagnostic value of calprotectin for PJI was evaluated by calculating sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), diagnostic score and area under SROC (AUC) based on the Stata version 14.0 software. We conduct subgroup analysis according to the study design, cutoff values, the country of study, and gold standard. Results Seven studies were included in this meta-analysis. The pooled sensitivity of synovial calprotectin for the diagnosis of PJI was 0.94 (95% CI, 0.87–0.98), and the specificity was 0.93 (95% CI, 0.87–0.96). The pooled AUC, PLR, and NLR for synovial calprotectin were 0.98 (95% CI, 0.96–0.99), 13.65 (95% CI, 6.89–27.07), and 0.06 (95% CI, 0.02–0.15), respectively. The pooled diagnostic score and DOR were 5.4 (95% CI, 3.96–6.85) and 222.32 (95% CI, 52.52–941.12), respectively. Conclusion In summary, this meta-analysis indicates that synovial calprotectin is a promising biomarker of assistant diagnosis for PJI, as well as recommended test for excluding diagnostic tool.

Role of Biomarkers in Periprosthetic Joint Infections

“…Even though there are few studies on the use of the synovial calprotectin level in the diagnosis of PJI, a meta-analysis found that this biomarker had a specificity of 84–99% and sensitivity of 84–98% in the diagnosis of PJI [ 73 ].In light of these data, it has been stated that the synovial calprotectin level can be used as a reliable biomarker in the diagnosis of PJI and it has been argued that it may be preferred owing to its low cost [ 74 ]. These promising developments have been supported by the findings of another recent meta-analysis and study [ 75 , 76 ]. It is obvious that the synovial calprotectin level, a promising agent in the diagnosis of PJI, will increasingly occupy a place in daily practice in the future.…”

Serum and Synovial Markers in the Diagnosis of Periprosthetic Joint Infection of the Hip, Knee, and Shoulder: An Algorithmic Approach

“…In a study by Warren et al, synovial calprotectin at a threshold of 50 mg/L was shown to have an AUC of 0.969, a sensitivity of 98.1%, and a specificity of 95.7% 89 . Furthermore, in a meta-analysis, Peng et al found that synovial calprotectin demonstrated a pooled AUC of 0.980, sensitivity of 94.0%, and specificity of 93.0% 90 . However, the literature on calprotectin remains limited, and additional studies with larger sample sizes are required to determine its diagnostic utility in the workup of PJI.…”

Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023

“…While further research on calprotectin is necessary, according to recent diagnostic meta-analyses [ 117 , 118 ] synovial calprotectin has the potential to be a promising biomarker for diagnosing PJI due to its benefits, including its high diagnostic accuracy and convenience. However, it is important to note that current data are insufficient in order to be able to consider synovial calprotectin as a suitable stand-alone diagnostic marker for PJI.…”