Is Procalcitonin (PCT) a reliable biomarker for preoperative diagnosing of low grade periprosthetic joint infection? A prospective study.
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ABSTRACT:
SUBMITTER: Busch A
PROVIDER: S-EPMC7171844 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
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Project description:ObjectiveThe 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.MethodsWe 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.ResultsTwo 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.ConclusionsThe 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.
| S-EPMC9627080 | biostudies-literature
Project description:Periprosthetic joint infection (PJI) is a catastrophic complication following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with difficulties, which is characterized by technical limitations. The question of whether sonication fluid PCR can provide high value in the diagnosis of PJI remains unanswered. This meta-analysis included 9 studies that evaluated PCR assays of sonication fluid for the diagnosis of PJI. The pooled sensitivity, specificity, Positive likelihood ratio (PLR), Negative likelihood ratio (NLR) and Diagnostic odds ratio (DOR) were 0.75 (95% confidence interval [CI], 0.71 to 0.81), 0.96 (CI, 0.94 to 0.97), 18.24 (CI, 6.07 to 54.78), 0.27 (CI, 0.20 to 0.36) and 86.97 (CI, 37.08 to 203.97), respectively. The AUC value of the SROC was 0.9244 (standard error, 0.0212). Subgroup analyses showed that use of multiplex PCR and may improve sensitivity and specificity. The results of this meta-analysis showed that PCR of fluid after sonication is reliable and of great value in PJI diagnosis.
| S-EPMC5922553 | biostudies-literature
Project description:Blood biomarkers are first-line tools for identifying periprosthetic joint infection (PJI). C-reactive protein (CRP) is currently recognized as the standard biomarker for PJI diagnosis. Other recently reported novel biomarkers, including plasma fibrinogen, platelet count, monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), and platelet count/lymphocyte ratio (PLR), have also shown promise in diagnosing PJI. This study aimed to evaluate whether these biomarkers were superior to CRP for identifying PJI. Patients who underwent revision hip or knee arthroplasty at our hospital from January 2008 to September 2020 were included consecutively and divided into infected and non-infected groups according to the 2013 International Consensus Meeting Criteria. Blood samples were collected preoperatively, and erythrocyte sedimentation rate (ESR), CRP, interleukin-6, fibrinogen, platelet count, MLR, NLR, and PLR were analyzed. The diagnostic values of the tested biomarkers and their combinations were compared with CRP based on the area under the receiver operating characteristic curve (AUC) using the z-test. Classification trees were constructed to explore more accurate combinations of the tested markers for identifying PJI. A total of 543 patients were included, of whom 245 had PJI. Among the tested biomarkers, CRP with a cutoff of 7.39 mg/L showed the highest AUC, which gave a sensitivity of 79.1% and specificity of 86.0%. The AUCs of pairwise combinations of tested markers including CRP also were inferior to CRP itself, as were combinations derived from classification trees. Preoperative serum CRP with a low cutoff may be the best reliable blood biomarker for identifying PJI, and those traditional or novel available blood biomarkers could not further improve the diagnostic ability on the basis of CRP.
| S-EPMC9030667 | biostudies-literature
Project description:ObjectiveThis study aimed to assess the diagnostic value of metagenomic next-generation sequencing (mNGS) across synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues among patients with periprosthetic joint infection (PJI), intending to optimize specimen selection for mNGS in these patients.MethodsThis prospective study involved 61 patients undergoing revision arthroplasty between September 2021 and September 2022 at the First Affiliated Hospital of Zhengzhou University. Among them, 43 cases were diagnosed as PJI, and 18 as aseptic loosening (AL) based on the American Musculoskeletal Infection Society (MSIS) criteria. Preoperative or intraoperative synovial fluid, periprosthetic tissues, and prosthetic sonicate fluid were collected, each divided into two portions for mNGS and culture. Comparative analyses were conducted between the microbiological results and diagnostic efficacy derived from mNGS and culture tests. Furthermore, the variability in mNGS diagnostic efficacy for PJI across different specimen types was assessed.ResultsThe sensitivity and specificity of mNGS diagnosis was 93% and 94.4% for all types of PJI specimens; the sensitivity and specificity of culture diagnosis was 72.1% and 100%, respectively. The diagnostic sensitivity of mNGS was significantly higher than that of culture (X2 = 6.541, P=0.011), with no statistically significant difference in specificity (X2 = 1.029, P=0.310). The sensitivity of the synovial fluid was 83.7% and the specificity was 94.4%; the sensitivity of the prosthetic sonicate fluid was 90.7% and the specificity was 94.4%; and the sensitivity of the periprosthetic tissue was 81.4% and the specificity was 100%. Notably, the mNGS of prosthetic sonicate fluid displayed a superior pathogen detection rate compared to other specimen types.ConclusionmNGS can function as a precise diagnostic tool for identifying pathogens in PJI patients using three types of specimens. Due to its superior ability in pathogen identification, prosthetic sonicate fluid can replace synovial fluid and periprosthetic tissue as the optimal sample choice for mNGS.
| S-EPMC10945027 | biostudies-literature
Project description:BackgroundCulture-negative periprosthetic joint infections (PJI) are often false diagnosed as aseptic implant failure leading to unnecessary revision surgeries due to repeated infections. A marker to increase the security of e PJI diagnosis is therefore of great importance. The aim of this study was to test C9 immunostaining of periprosthetic tissue as a novel tissue-biomarker for a more reliable identification of PJI, as well as potential cross-reactivity.MethodWe included 98 patients in this study undergoing septic or aseptic revision surgeries. Standard microbiological diagnosis was performed in all cases for classification of patients. Serum parameters including C-reactive protein (CRP) serum levels and white blood cell (WBC) count were included, and the periprosthetic tissue was immunostained for C9 presence. The amount of C9 tissue staining was evaluated in septic versus aseptic tissue and the amount of C9 staining was correlated with the different pathogens causing the infection. To exclude cross-reactions between C9 immunostaining and other inflammatory joint conditions, we included tissue samples of a separate cohort with rheumatoid arthritis, wear particles and chondrocalcinosis.ResultsThe microbiological diagnosis detected PJI in 58 patients; the remaining 40 patients were classified as aseptic. Serum CRP values were significantly increased in the PJI cohort. Serum WBC was not different between septic and aseptic cases. We found a significant increase in C9 immunostaining in the PJI periprosthetic tissue. To test the predictive value of C9 as biomarker for PJI we performed a ROC analyses. According to the Youden's criteria C9 is a very good biomarker for PJI detection with a sensitivity of 89% and a specificity of 75% and an AUC of 0.84. We did not observe a correlation of C9 staining with the pathogen causing the PJI. However, we observed a cross reactivity with the inflammatory joint disease like rheumatoid arthritis and different metal wear types. In addition, we did not observe a cross reactivity with chondrocalcinosis.ConclusionOur study identifies C9 as a potential tissue-biomarker for the identification of PJI using immunohistological staining of tissue biopsies. The use of C9 staining could help to reduce the number of false negative diagnoses of PJI.
| S-EPMC9989178 | biostudies-literature
Project description:BackgroundThe aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients.MethodsIn this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study.ResultsOver the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18-27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25-3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04-5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51-2.52 for PCT; aOR 1.32, 95% CI 0.66-2.64 for PCT-72 h).ConclusionElevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting.
| S-EPMC10573961 | biostudies-literature
Project description:Periprosthetic joint infection (PJI), a devastating complication of total joint replacement, is of incompletely understood pathogenesis and may sometimes be challenging to clinically distinguish from other causes of arthroplasty failure. We characterized human gene expression in 93 specimens derived from surfaces of resected arthroplasties, comparing transcriptomes of subjects with infection- versus non-infection-associated arthroplasty failure. Differential gene expression analysis confirmed 28 previously reported potential biomarkers of PJI, including bactericidal/permeability increasing protein (BPI), cathelicidin antimicrobial peptide (CAMP), C-C-motif chemokine ligand 3 (CCL3), 4(CCL4), and C-X-C-motif chemokine ligand 2 (CXCL2), colony stimulating factor 2 receptor beta (CSF2RB), colony stimulating factor 3 (CSF3), alpha-defensin (DEFA4), Fc fragment of IgG receptor 1B (CD64B), intercellular adhesion molecule 1 (ICAM1), interferon gamma (IFNG), interleukin 13 receptor subunit alpha 2 (IL13RA2), interleukin 17D (IL17D), interleukin 1 (IL1A, IL1B, IL1RN), interleukin 2 receptors (IL2RA, IL2RG), interleukin 5 receptor (IL5RA), interleukin 6 (IL6), interleukin 8 (IL8), lipopolysaccharide binding protein (LBP), lipocalin (LCN2), lactate dehydrogenase C (LDHC), lactotransferrin (LTF), matrix metallopeptidase 3 (MMP3), peptidase inhibitor 3 (PI3), and vascular endothelial growth factor A (VEGFA), and identified three novel molecules of potential diagnostic use for detection of PJI, namely C-C-motif chemokine ligand CCL20, coagulation factor VII (F7), and B cell receptor FCRL4. Comparative analysis of infections caused by staphylococci versus bacteria other than staphylococci and Staphylococcus aureus versus Staphylococcus epidermidis showed elevated expression of interleukin 13 (IL13), IL17D, and MMP3 in staphylococcal infections, and of IL1B, IL8, and platelet factor PF4V1 in S. aureus compared to S. epidermidis infections. Pathway analysis of over-represented genes suggested activation of host immune response and cellular maintenance and repair functions in response to invasion of infectious agents. The data presented provides new potential targets for diagnosis of PJI and for differentiation of PJI caused by different infectious agents.
2024-02-19 | GSE255786 | GEO
Project description:The D-dimer test is a component of the modified scoring criteria for periprosthetic joint infection (PJI). The performance of the D-dimer test varies greatly among laboratories because of the lack of standardization. Laboratories may use different assays and will produce widely varying results for the same sample. This study used published proficiency testing data from 3903 laboratories to demonstrate the variability in D-dimer results and estimate the misclassification rate of patients using the proposed cutoff for the test as a component of PJI criteria. Given the variability in D-dimer results, a clinically significant percentage of patients are likely to be misclassified. The data illustrate that a universal cutoff for this marker in the context of assessment for PJI is not appropriate. Each site must conduct a study to determine an appropriate cutoff for their unique testing platform.
| S-EPMC7451938 | biostudies-literature
Project description:Background Because there is no single gold standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection appears to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI. Methods PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019. Results Eight studies were included in the meta-analysis. The pooled sensitivity was 0.84 (95% confidence interval [CI], 0.80?0.88) for the combined method (serum IL-6 and CRP) in series and parallel approaches, 0.87 (95% CI, 0.82?0.90) for IL-6, and 0.84 (95% CI, 0.79?0.88) for CRP. The pooled specificity was 0.85 (95% CI, 0.82?0.88) for the combined method, 0.83 (95% CI, 0.79?0.87) for IL-6, and 0.83 (95% CI, 0.79?0.87) for CRP. The combined method had the highest value for the area under the curve (0.9453), followed by IL-6 (0.9237) and CRP (0.9074). Subgroup analyses showed that the sensitivity of the combined method in parallel tests was higher than that in IL-6 or CRP (94% vs. 89% and 84%, respectively). Serial testing of the combined method showed increased specificity compared to a single indicator (96% vs. 83% and 80%). Conclusion The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of periprosthetic hip and knee infection, demonstrating a better diagnostic accuracy than single marker analysis.
| S-EPMC7532114 | biostudies-literature
Project description:BackgroundThis study aimed to evaluate ChatGPT's performance on questions about periprosthetic joint infections (PJI) of the hip and knee.MethodsTwenty-seven questions from the 2018 International Consensus Meeting on Musculoskeletal Infection were selected for response generation. The free-text responses were evaluated by three orthopedic surgeons using a five-point Likert scale. Inter-rater reliability (IRR) was assessed via Fleiss' kappa (FK).ResultsOverall, near-perfect IRR was found for disagreement on the presence of factual errors (FK: 0.880, 95% CI [0.724, 1.035], p < 0.001) and agreement on information completeness (FK: 0.848, 95% CI [0.699, 0.996], p < 0.001). Substantial IRR was observed for disagreement on misleading information (FK: 0.743, 95% CI [0.601, 0.886], p < 0.001) and agreement on suitability for patients (FK: 0.627, 95% CI [0.478, 0.776], p < 0.001). Moderate IRR was observed for agreement on "up-to-dateness" (FK: 0.584, 95% CI [0.434, 0.734], p < 0.001) and suitability for orthopedic surgeons (FK: 0.505, 95% CI [0.383, 0.628], p < 0.001). Question- and subtopic-specific analysis revealed diverse IRR levels ranging from near-perfect to poor.ConclusionsChatGPT's free-text responses to complex orthopedic questions were predominantly reliable and useful for orthopedic surgeons and patients. Given variations in performance by question and subtopic, consulting additional sources and exercising careful interpretation should be emphasized for reliable medical decision-making.
| S-EPMC10607052 | biostudies-literature