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Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections
Introduction This retrospective study was undertaken to define cut-off values for synovial fluid (SF) leukocyte count and neutrophil percentage for differentiating aseptic failure and periprosthetic joint infection (PJI) and to evaluate the diagnostic accuracy of blood inflammatory markers, and micr...
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| Published in: | Archives of orthopaedic and trauma surgery 2018-02, Vol.138 (2), p.165-171 |
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| creator | Balato, Giovanni Franceschini, Vincenzo Ascione, Tiziana Lamberti, Alfredo Balboni, Fiamma Baldini, Andrea |
| description | Introduction
This retrospective study was undertaken to define cut-off values for synovial fluid (SF) leukocyte count and neutrophil percentage for differentiating aseptic failure and periprosthetic joint infection (PJI) and to evaluate the diagnostic accuracy of blood inflammatory markers, and microbiological testing according to the criteria proposed by the International Consensus Meeting (ICM) of Philadelphia.
Methods
All patients who underwent revision total knee arthroplasty from January 2010 to July 2015 were included: we identified and classified 31 PJIs and 136 aseptic joints. The diagnostic performance of single test was assessed by receiver operating characteristic curve analyses. The sensitivity and specificity were calculated for each of the cut-off values and the area under the curve (AUC) was calculated.
Results
The median SF leukocyte count as well as the neutrophil percentage and inflammatory markers were significantly higher in patients with PJI than in those with aseptic failure (
p
2.8 × 10
3
/μL had a sensitivity of 83.8% and a specificity of 89.7% whereas a neutrophil percentage of > 72% yielded a marginally higher sensitivity of 84% and a specificity of 91%. Applying the ICM criteria we found a significant correlation between all these diagnostic measures and PJI (
p
|
| doi_str_mv | 10.1007/s00402-017-2832-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1961036243</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1961036243</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-ec12104e8c190cd037eb295743838b35f418a758193f0249495745f88a0854bb3</originalsourceid><addsrcrecordid>eNp1kU9rGzEQxUVJqR23H6CXIsglh2w6I2l3pWPJfwj00p6FVtY6iteSK3kT_O2jxWkDhZyEmN-8eTOPkK8I5wjQfs8AAlgF2FZMclY1H8gcBRcVV9gckTko3lQSapyR45wfAZBJBZ_IjCkEDq2Yk-dLb1Yh5p231Fg7JmP3NPY070N88mag_TD65RnthhiXdGPS2qV8Rk0oH29T7Hwc4srbQu5cUQkr6gO1DymGorgOztFtKvIPbprgQ-_szseQP5OPvRmy-_L6Lsjv66tfF7fV_c-bu4sf95XlLdtVziJDEE5aVGCXwFvXMVW3gksuO173AqVpa4mK98CEElOt7qU0IGvRdXxBTg-6xcWfsTjUG5-tGwYTXByzRtWUUzRM8IKe_Ic-xjGF4k4z1qBUXGJTKDxQZfmck-v1Nvlyl71G0FMq-pCKLqnoKRU99Xx7VR67jVv-6_gbQwHYAcilFFYuvY1-X_UFFYKXJQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2261893816</pqid></control><display><type>article</type><title>Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections</title><source>Springer Nature</source><creator>Balato, Giovanni ; Franceschini, Vincenzo ; Ascione, Tiziana ; Lamberti, Alfredo ; Balboni, Fiamma ; Baldini, Andrea</creator><creatorcontrib>Balato, Giovanni ; Franceschini, Vincenzo ; Ascione, Tiziana ; Lamberti, Alfredo ; Balboni, Fiamma ; Baldini, Andrea</creatorcontrib><description>Introduction
This retrospective study was undertaken to define cut-off values for synovial fluid (SF) leukocyte count and neutrophil percentage for differentiating aseptic failure and periprosthetic joint infection (PJI) and to evaluate the diagnostic accuracy of blood inflammatory markers, and microbiological testing according to the criteria proposed by the International Consensus Meeting (ICM) of Philadelphia.
Methods
All patients who underwent revision total knee arthroplasty from January 2010 to July 2015 were included: we identified and classified 31 PJIs and 136 aseptic joints. The diagnostic performance of single test was assessed by receiver operating characteristic curve analyses. The sensitivity and specificity were calculated for each of the cut-off values and the area under the curve (AUC) was calculated.
Results
The median SF leukocyte count as well as the neutrophil percentage and inflammatory markers were significantly higher in patients with PJI than in those with aseptic failure (
p
< 0.001). A leukocyte count of > 2.8 × 10
3
/μL had a sensitivity of 83.8% and a specificity of 89.7% whereas a neutrophil percentage of > 72% yielded a marginally higher sensitivity of 84% and a specificity of 91%. Applying the ICM criteria we found a significant correlation between all these diagnostic measures and PJI (
p
< 0.001) except for a single positive culture. The most accurate criterion of the ICM was the synovial neutrophil differential (AUC = 0.89; 95% CI 0.81–0.97), followed by SF leukocyte count (AUC = 0.86; 95% CI 0.78–0.94), increased inflammatory markers (AUC = 0.85; 95% CI 0.76–0.93), and two positive periprosthetic cultures (AUC = 0.84; 95% CI 0.73–0.94). The presence of sinus tract communicating with the joint and a single positive culture showed unfavourable diagnostic accuracy (AUC = 0.60, 95% CI 0.47–0.72; AUC = 0.49, 95% CI 0.38–0.61, respectively)
Conclusions
The present study highlights the adequate ability of fluid cell count and neutrophil differential to distinguish between PJI and aseptic loosening. The clinical utility of fluid analysis in diagnosing infection can be improved by evaluation of other diagnostic criteria.
Level of evidence
Level I Diagnostic Study.</description><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-017-2832-6</identifier><identifier>PMID: 29103074</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Accuracy ; Joint surgery ; Medical diagnosis ; Medicine ; Medicine & Public Health ; Neutrophils ; Orthopaedic Surgery ; Orthopedics</subject><ispartof>Archives of orthopaedic and trauma surgery, 2018-02, Vol.138 (2), p.165-171</ispartof><rights>Springer-Verlag GmbH Germany 2017</rights><rights>Archives of Orthopaedic and Trauma Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-ec12104e8c190cd037eb295743838b35f418a758193f0249495745f88a0854bb3</citedby><cites>FETCH-LOGICAL-c372t-ec12104e8c190cd037eb295743838b35f418a758193f0249495745f88a0854bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29103074$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Balato, Giovanni</creatorcontrib><creatorcontrib>Franceschini, Vincenzo</creatorcontrib><creatorcontrib>Ascione, Tiziana</creatorcontrib><creatorcontrib>Lamberti, Alfredo</creatorcontrib><creatorcontrib>Balboni, Fiamma</creatorcontrib><creatorcontrib>Baldini, Andrea</creatorcontrib><title>Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>Introduction
This retrospective study was undertaken to define cut-off values for synovial fluid (SF) leukocyte count and neutrophil percentage for differentiating aseptic failure and periprosthetic joint infection (PJI) and to evaluate the diagnostic accuracy of blood inflammatory markers, and microbiological testing according to the criteria proposed by the International Consensus Meeting (ICM) of Philadelphia.
Methods
All patients who underwent revision total knee arthroplasty from January 2010 to July 2015 were included: we identified and classified 31 PJIs and 136 aseptic joints. The diagnostic performance of single test was assessed by receiver operating characteristic curve analyses. The sensitivity and specificity were calculated for each of the cut-off values and the area under the curve (AUC) was calculated.
Results
The median SF leukocyte count as well as the neutrophil percentage and inflammatory markers were significantly higher in patients with PJI than in those with aseptic failure (
p
< 0.001). A leukocyte count of > 2.8 × 10
3
/μL had a sensitivity of 83.8% and a specificity of 89.7% whereas a neutrophil percentage of > 72% yielded a marginally higher sensitivity of 84% and a specificity of 91%. Applying the ICM criteria we found a significant correlation between all these diagnostic measures and PJI (
p
< 0.001) except for a single positive culture. The most accurate criterion of the ICM was the synovial neutrophil differential (AUC = 0.89; 95% CI 0.81–0.97), followed by SF leukocyte count (AUC = 0.86; 95% CI 0.78–0.94), increased inflammatory markers (AUC = 0.85; 95% CI 0.76–0.93), and two positive periprosthetic cultures (AUC = 0.84; 95% CI 0.73–0.94). The presence of sinus tract communicating with the joint and a single positive culture showed unfavourable diagnostic accuracy (AUC = 0.60, 95% CI 0.47–0.72; AUC = 0.49, 95% CI 0.38–0.61, respectively)
Conclusions
The present study highlights the adequate ability of fluid cell count and neutrophil differential to distinguish between PJI and aseptic loosening. The clinical utility of fluid analysis in diagnosing infection can be improved by evaluation of other diagnostic criteria.
Level of evidence
Level I Diagnostic Study.</description><subject>Accuracy</subject><subject>Joint surgery</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neutrophils</subject><subject>Orthopaedic Surgery</subject><subject>Orthopedics</subject><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kU9rGzEQxUVJqR23H6CXIsglh2w6I2l3pWPJfwj00p6FVtY6iteSK3kT_O2jxWkDhZyEmN-8eTOPkK8I5wjQfs8AAlgF2FZMclY1H8gcBRcVV9gckTko3lQSapyR45wfAZBJBZ_IjCkEDq2Yk-dLb1Yh5p231Fg7JmP3NPY070N88mag_TD65RnthhiXdGPS2qV8Rk0oH29T7Hwc4srbQu5cUQkr6gO1DymGorgOztFtKvIPbprgQ-_szseQP5OPvRmy-_L6Lsjv66tfF7fV_c-bu4sf95XlLdtVziJDEE5aVGCXwFvXMVW3gksuO173AqVpa4mK98CEElOt7qU0IGvRdXxBTg-6xcWfsTjUG5-tGwYTXByzRtWUUzRM8IKe_Ic-xjGF4k4z1qBUXGJTKDxQZfmck-v1Nvlyl71G0FMq-pCKLqnoKRU99Xx7VR67jVv-6_gbQwHYAcilFFYuvY1-X_UFFYKXJQ</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Balato, Giovanni</creator><creator>Franceschini, Vincenzo</creator><creator>Ascione, Tiziana</creator><creator>Lamberti, Alfredo</creator><creator>Balboni, Fiamma</creator><creator>Baldini, Andrea</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20180201</creationdate><title>Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections</title><author>Balato, Giovanni ; Franceschini, Vincenzo ; Ascione, Tiziana ; Lamberti, Alfredo ; Balboni, Fiamma ; Baldini, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-ec12104e8c190cd037eb295743838b35f418a758193f0249495745f88a0854bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Accuracy</topic><topic>Joint surgery</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neutrophils</topic><topic>Orthopaedic Surgery</topic><topic>Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Balato, Giovanni</creatorcontrib><creatorcontrib>Franceschini, Vincenzo</creatorcontrib><creatorcontrib>Ascione, Tiziana</creatorcontrib><creatorcontrib>Lamberti, Alfredo</creatorcontrib><creatorcontrib>Balboni, Fiamma</creatorcontrib><creatorcontrib>Baldini, Andrea</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of orthopaedic and trauma surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Balato, Giovanni</au><au>Franceschini, Vincenzo</au><au>Ascione, Tiziana</au><au>Lamberti, Alfredo</au><au>Balboni, Fiamma</au><au>Baldini, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections</atitle><jtitle>Archives of orthopaedic and trauma surgery</jtitle><stitle>Arch Orthop Trauma Surg</stitle><addtitle>Arch Orthop Trauma Surg</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>138</volume><issue>2</issue><spage>165</spage><epage>171</epage><pages>165-171</pages><issn>0936-8051</issn><eissn>1434-3916</eissn><abstract>Introduction
This retrospective study was undertaken to define cut-off values for synovial fluid (SF) leukocyte count and neutrophil percentage for differentiating aseptic failure and periprosthetic joint infection (PJI) and to evaluate the diagnostic accuracy of blood inflammatory markers, and microbiological testing according to the criteria proposed by the International Consensus Meeting (ICM) of Philadelphia.
Methods
All patients who underwent revision total knee arthroplasty from January 2010 to July 2015 were included: we identified and classified 31 PJIs and 136 aseptic joints. The diagnostic performance of single test was assessed by receiver operating characteristic curve analyses. The sensitivity and specificity were calculated for each of the cut-off values and the area under the curve (AUC) was calculated.
Results
The median SF leukocyte count as well as the neutrophil percentage and inflammatory markers were significantly higher in patients with PJI than in those with aseptic failure (
p
< 0.001). A leukocyte count of > 2.8 × 10
3
/μL had a sensitivity of 83.8% and a specificity of 89.7% whereas a neutrophil percentage of > 72% yielded a marginally higher sensitivity of 84% and a specificity of 91%. Applying the ICM criteria we found a significant correlation between all these diagnostic measures and PJI (
p
< 0.001) except for a single positive culture. The most accurate criterion of the ICM was the synovial neutrophil differential (AUC = 0.89; 95% CI 0.81–0.97), followed by SF leukocyte count (AUC = 0.86; 95% CI 0.78–0.94), increased inflammatory markers (AUC = 0.85; 95% CI 0.76–0.93), and two positive periprosthetic cultures (AUC = 0.84; 95% CI 0.73–0.94). The presence of sinus tract communicating with the joint and a single positive culture showed unfavourable diagnostic accuracy (AUC = 0.60, 95% CI 0.47–0.72; AUC = 0.49, 95% CI 0.38–0.61, respectively)
Conclusions
The present study highlights the adequate ability of fluid cell count and neutrophil differential to distinguish between PJI and aseptic loosening. The clinical utility of fluid analysis in diagnosing infection can be improved by evaluation of other diagnostic criteria.
Level of evidence
Level I Diagnostic Study.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29103074</pmid><doi>10.1007/s00402-017-2832-6</doi><tpages>7</tpages></addata></record> |
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| subjects | Accuracy Joint surgery Medical diagnosis Medicine Medicine & Public Health Neutrophils Orthopaedic Surgery Orthopedics |
| title | Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections |
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