Synovial fluid presepsin as a novel biomarker for the rapid differential diagnosis of native joint septic arthritis from crystal arthritis

Abstract

To investigate whether presepsin can be used as a novel biomarker to differentiate between native joint septic arthritis (NJSA) and crystal arthritis (CA). Methods: This study included 75 patients diagnosed with either NJSA (n = 21) or CA (n = 54). Presepsin in synovial fluid and blood, C-reactive protein, and procalcitonin were measured and compared between the NJSA and CA groups. Receiver operating characteristic (ROC) curve analyses were performed to differentiate between the two groups. Results: Synovial fluid and blood presepsin were significantly higher in the NJSA group than in the CA group (p < 0.0001 and p < 0.01, respectively). The area under the ROC curve for synovial fluid presepsin in the NJSA group compared with the CA group was 0.93 (sensitivity 85.7%, specificity 85.2%, positive predictive value 69.2%, negative predictive value 93.9%, positive likelihood ratio 5.79, negative likelihood ratio 0.17). Among the tests, synovial fluid presepsin was the most accurate. Conclusions: Measurement of synovial fluid presepsin is reliable for the early diagnosis of NJSA, and synovial fluid presepsin could be used as a novel biomarker for differentiating between NJSA and CA.

Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee

“…In this study, intra‐operative findings and synovial fluid markers such as synovial WBC counts were not associated with the need for secondary surgery. Whilst there appears to be ample evidence advocating for the use of synovial white blood cell counts to diagnose septic arthritis [11, 13, 21], the role of synovial white blood cell counts to predict effectiveness of surgical debridement for septic arthritis is less established [29]. Stake et al [30] found that taken in isolation, the increased synovium WBC counts did not significantly predict patients who required secondary surgery for knee septic arthritis.…”

Utility of urinary presepsin in the diagnosis of pyelonephritis: A cross-sectional study

“…Presepsin has been attracting attention as a useful marker for diagnosis and prognosis in sepsis [6]. Since presepsin production is increased at the site of infection, its measurement in the joint uid is effective in differentiating pyogenic arthritis from crystalline arthritis [7].…”

Utility of urinary presepsin in the diagnosis of pyelonephritis: a cross-sectional study

“…Presepsin has been attracting attention as a useful marker for diagnosis and prognosis in sepsis [ 6 ]. Since presepsin production is increased at the site of infection, its measurement in the joint fluid is effective in differentiating pyogenic arthritis from crystalline arthritis [ 7 ]. The cerebrospinal fluid presepsin is also useful for the diagnosis and prognosis of post-neurosurgical ventriculitis/meningitis [ 8 ].…”