Relevant factors of serum tests did not meet the diagnostic threshold in patients with periprosthetic joint infection / 中华骨科杂志

ABSTRACT

Objective:To investigate the relevant factors on serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) which did not meet the 2011 Musculoskeletal Infection Society (MSIS) diagnostic criteria in patients with periprosthetic joint infection (PJI).Methods:During December 2011 to December 2019, a total of 328 patients with PJI were hospitalized for surgery or antibiotic administration, including 152 males and 166 females, aged 62.10±13.74 (range 24-87) years. All patients underwent CRP and ESR before the antibiotic administration or the revision surgery. PJI was diagnosed based on the 2011 MSIS diagnostic criteria. There were 172 knee PJIs (52.4%), 151 hip PJIs (46.0%), 4 elbow PJIs (1.2%) and 1 shoulder PJI (0.3%). Patients were classified according to Tsukayama type, pathogen and immune status. We, further, analyzed relevant factors on CRP and ESR levels in PJI patients.Results:There were 119 patients with CRP and ESR did not meet the MSIS diagnostic criteria, accounting for 36.3% (119/328). Furthermore, there was no significant difference in Tsukayama types among them (χ 2=7.224, P=0.065). In addition, the ratio was 46.4% in patients with negative culture results, which was higher than that in positive culture results (27.4%, χ 2=12.276, P<0.001). The ratio was 42.9% in patients with normal immune status (grade A), which was higher than that of immune grade B (30.6%) and of immune grade C (23.8%) (χ 2=6.586, P=0.037). Multivariate logistic regression analysis showed the negative association between positive culture results and immune grade B with nonconformity ( OR=0.420, P=0.001; OR=0.578, P=0.04). Conclusion:The serum tests level unmet the threshold in MSIS criteria usually present in PJI patients with normal immune status and negative culture results. Thus, we should utilize other methods for diagnosing PJI.