Values of combined detection of indexes related to serum inflammation and platelet in diagnosis of chronic periprosthetic joint infection / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the values of combined detection of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet count (PC), platelet count/mean platelet volume (PC/MPV) and platelet plateletcrit (PCT) in the diagnosis of chronic periprosthetic joint infection (PJI).Methods:From January 2013 to December 2019, 441 patients underwent hip or knee joint revision at Department of Articular Surgery, The First Hospital Affiliated to Xinjiang Medical University. The patients were divided into a chronic PJI group and an aseptic prosthetic loosening group. In the chronic PJI group of 147 cases (86 hip ones and 61 knee ones), there were 64 males and 83 females, with a mean age of 66 (54, 72) years. In the aseptic prosthetic loosening group of 294 cases (210 hip ones and 84 knee ones), there were 98 males and 196 females, with a mean age of 63 (49, 72) years. The preoperative levels of CRP, ESR, PC, PC/MPV and PCT were compared between the 2 groups. The best cut-off value, sensitivity and specificity of the above indicators for the diagnosis of chronic PJI were recorded. The diagnostic efficacy of the 5 indicators in combination for chronic PJI was evaluated by comparing the area under the curve (AUC) among the indicators and analyzing the results of combined diagnostic detections.Results:Except for gender and joint revision site, there was no significant difference in the other general data between the 2 groups, showing comparability ( P>0.05). The levels of CRP, ESR, PC, PC/MPV and PCT in the PJI group were significantly higher than those in the aseptic prosthetic loosening group ( P<0.05). For CRP, ESR, PC, PC/MPV and PCT, respectively, the best cut-off values were 9.05 mg/L, 38.5 mm/h, 288×10 9/L, 29.34 and 0.33%, the sensitivities 83%, 71%, 44%, 44% and 33%, the specificities 85%, 86%, 84%, 84% and 90%, and the AUCs 0.868, 0.822, 0.688, 0.696 and 0.659. For CRP+ESR+PC+PC/MPV+PCT and CRP+PC+PC/MPV+PCT, respectively, the AUCs were 0.871 and 0.882, the sensitivities 80% and 84%, and the specificities 86% and 84%, showing significant differences in the diagnosis of chronic PJI compared with ESR, PC, PC/MPV and PCT alone ( P<0.05). Conclusion:In the diagnosis of chronic PJI, serum CRP and ESR combined with PC, PC/MPV and PCT have a reference value, but PC, PC/MPV or PCT alone only has a limited value.