Synovial fluid IL-1β appears useful for the diagnosis of chronic periprosthetic joint infection

Wang, Hai; Qin, Leilei; Wang, Jiawei; Huang, Wei

doi:10.21203/rs.3.rs-157718/v1

Cited by 4 publications

(6 citation statements)

References 10 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%

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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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“…A number of specific biomarkers showed promise in the diagnosis of PJI, including synovial soluble tumor necrosis factor receptor 2 (sTNF-R2) 33 , synovial fluid interleukin-1 beta (IL-1β) (especially in combination with the polymorphonuclear [PMN] percentage) 34 , and calprotectin (of note, calprotectin did not reliably differentiate PJI from rheumatoid arthritis in this study) 35 . In 1 study, a calprotectin point-of-care test showed high sensitivity and specificity (>95%) in the diagnosis of PJI after TKA 36 .…”

Section: Diagnosismentioning

confidence: 86%

What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2022

Journal of Bone and Joint Surgery

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Periprosthetic joint infection (PJI) remains the most dreaded complication after total joint arthroplasty (TJA). As reimbursement for joint replacement continues to decline [1][2][3] , fewer orthopaedic surgeons take on this challenging and timeconsuming practice. Indeed, in a recent study, Keely Boyle et al. found that 16% of knee arthroplasty revisions, including revisions for infection, were performed at a different center than the one in which the index procedure was performed. Illgen et al. used the American Joint Replacement Registry (AJRR) to show that, in hips, the migration rate for PJI ranges from 28.6% to 46.6%, depending on the size of the hospital 5 . This places a major portion of the responsibility of PJI care on a few specialized surgeons. Therefore, understanding the economics of PJI care has been a hot topic this year.In a study utilizing the National Inpatient Sample (NIS), Premkumar et al. projected that, by 2030, the annual hospital costs related to PJI of the hip and knee will equal $1.85 billion in the United States 6 . In another study from a single institution, the cost of care for a PJI after a 2-stage total knee arthroplasty (TKA) was more than 5 times the cost of care of an uncomplicated primary TKA for an age-matched and body mass index (BMI)-matched cohor t 7 . Comparing the cost of operative treatment for PJI of the hip and knee with that of aseptic revision, Yao et al. 8 showed that the PJI treatment had costs that were double those of the aseptic treatment. Unintended hospitalization during the 2-stage exchange process was shown to add >$20,000 in costs to patient care, which is concerning because less than one-half of the patients who underwent resection for PJI had a successful 2-stage exchange within 1 year 9 . Using a Markov model, Antonios et al. showed the costeffectiveness of adding a planned second debridement, antibiotics, and implant retention (DAIR) procedure to treat PJI 10 . Efforts to reduce failure in PJI treatment will continue to be an important topic in research. PreventionAlthough originally spoken to Philadelphians to increase fire awareness in the 1700s, Benjamin Franklin's famous quote, "An ounce of prevention is worth a pound of cure," certainly still applies to PJI. With the substantial clinical and financial burden of PJI, resources should be focused, not just on treatment, but on optimizing strategies to prevent infection. Many studies published on this topic at this time will help to guide orthopaedic surgeons and their perioperative management of patients undergoing total hip arthroplasty (THA) and TKA, while prompting more prospective studies to answer important questions.Preoperative Staphylococcus aureus screening is controversial. In a recent systematic review and meta-analysis with 32 studies, Ribau et al. identified a marked reduction in infection with decolonization prior to elective THA and TKA 11 . However, in a randomized controlled trial (RCT) of 613 patients, Rohrer et al. did not find a difference in PJI rates with nasal decolonization, but...

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“…16,17,20 In recent research performed by Ivy et al, 18 the diagnostic value of synovial α defensin in PJI was not superior to that of synovial white blood cell (WBC) count and polymorphonuclear neutrophil percentage (PMN%), but its test costs were higher than synovial WBC and PMN% test. There are other synovial biomarkers, including interleukin (IL)-1β, IL-6, cysteine-rich with EGF-like domains 2 and calprotectin, etc, 15,[21][22][23][24][25] but whether these really have a role in PJI diagnosis has not yet been established, as the sensitivities and specificities reported by previous studies are different. 15,21,22,25 Therefore, it is urgent to develop a novel biomarker to diagnose PJI precisely.…”

Section: Introductionmentioning

confidence: 99%

Synovial fluid neutrophil extracellular traps could improve the diagnosis of periprosthetic joint infection

Cai

Liang

Chen

et al. 2023

Bone & Joint Research

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Aims This study aimed to explore the diagnostic value of synovial fluid neutrophil extracellular traps (SF-NETs) in periprosthetic joint infection (PJI) diagnosis, and compare it with that of microbial culture, serum ESR and CRP, synovial white blood cell (WBC) count, and polymorphonuclear neutrophil percentage (PMN%). Methods In a single health centre, patients with suspected PJI were enrolled from January 2013 to December 2021. The inclusion criteria were: 1) patients who were suspected to have PJI; 2) patients with complete medical records; and 3) patients from whom sufficient synovial fluid was obtained for microbial culture and NET test. Patients who received revision surgeries due to aseptic failure (AF) were selected as controls. Synovial fluid was collected for microbial culture and SF-WBC, SF-PNM%, and SF-NET detection. The receiver operating characteristic curve (ROC) of synovial NET, WBC, PMN%, and area under the curve (AUC) were obtained; the diagnostic efficacies of these diagnostic indexes were calculated and compared. Results The levels of SF-NETs in the PJI group were significantly higher than those of the AF group. The AUC of SF-NET was 0.971 (95% confidence interval (CI) 0.903 to 0.996), the sensitivity was 93.48% (95% CI 82.10% to 98.63%), the specificity was 96.43% (95% CI 81.65% to 99.91%), the accuracy was 94.60% (95% CI 86.73% to 98.50%), the positive predictive value was 97.73%, and the negative predictive value was 90%. Further analysis showed that SF-NET could improve the diagnosis of culture-negative PJI, patients with PJI who received antibiotic treatment preoperatively, and fungal PJI. Conclusion SF-NET is a novel and ideal synovial fluid biomarker for PJI diagnosis, which could improve PJI diagnosis greatly. Cite this article: Bone Joint Res 2023;12(2):113–120.

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Synovial fluid IL-1β appears useful for the diagnosis of chronic periprosthetic joint infection

Cited by 4 publications

References 10 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

What’s New in Musculoskeletal Infection

Synovial fluid neutrophil extracellular traps could improve the diagnosis of periprosthetic joint infection

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