Albumin to Globulin ratio, Neutrophil to Lymphocyte ratio, and Globulin levels do not outperform ESR or CRP when diagnosing periprosthetic joint infection.
Albumin to Globulin ratio, Neutrophil to Lymphocyte ratio, and Globulin levels do not outperform ESR or CRP when diagnosing periprosthetic joint infection.
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DOI：
10.1186/s12891-022-05357-y
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发表时间：
2022-04-30
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
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评估临床读数包括血清c反应蛋白（CRP）水平、红细胞沉降率（ESR）、球蛋白（GLB）水平、白蛋白与GLB比值（A/G）和中性粒细胞与淋巴细胞比值（NLR）在诊断假体周围关节感染（PJI）时的相对表现。我们收集了2017年1月至2020年12月在我科确诊的115例慢性PJI（女性29例，男性24例，中位年龄71.00岁[范围41-94岁]）或无菌性松动（女性30例，男性32例，中位年龄68.50岁[范围34-85岁]）的临床资料。比较患者人口统计学资料，评估术前GLB、ESR、CRP、NLR和A/G值作为PJI诊断预测因子的相对敏感性和特异性。PJI组和无菌组的中位球蛋白水平分别为31.700 g/L（四分位间距[IQR]， 28.400 ~ 35.300）和26.600 g/L（四分位间距[IQR]， 24.375 ~ 30.550），差异有统计学意义（p < 0.001）。PJI组和无菌组的中位A/G值分别为1.150 （IQR, 0.960 ~ 1.255）和1.510 (IQR, 1.265 ~ 1.670)，差异有统计学意义（p < 0.001）。PJI组和无菌组的NLR中位数分别为2.510 （IQR, 1.900 ~ 3.335）和1.850 (IQR, 1.425 ~ 2.362)，差异有统计学意义（p < 0.001）。PJI组和无菌组ESR中位数分别为53000 mm/h （IQR, 35.000 ~ 76.500）和16.000 mm/h (IQR, 7000 ~ 33.000)，差异有统计学意义（p < 0.001）。PJI组和无菌组CRP中位数分别为24.890 mg/L （IQR, 10.595 ~ 54.095）和2.245 mg/L (IQR, 0.865 ~ 8.6075)，差异有统计学意义（p < 0.001）。CRP、ESR、GLB、A/G、NLR的受试者工作特征曲线下面积（AUC）值分别为0.841（95%可信区间0.761 ~ 0.903）、0.850（0.771 ~ 0.910）、0.747（0.658 ~ 0.824）、0.779（0.692 ~ 0.851）、0.708（0.616 ~ 0.789）。当GLB > 26.6 g/L, A/ g < 1.32, NLR > 2.1作为PJI诊断的阈值时，发现GLB和A/ g比CRP（71.70%）和ESR（79.25%）表现出更高的敏感性（90.57%,81.13%），但这两个指标（GLB: 51.61%, A/ g: 72.58%）的特异性相对于CRP（87.10%）或ESR（75.81%）明显降低。ROC分析进一步显示NLR在敏感性（73.58%）和特异性（70.97%）上与CRP或ESR相比没有显著优势。当用于诊断PJI时，球蛋白水平、NLR值和A/G值并不优于ESR或CRP水平。在线版本包含补充材料，可在10.1186/s12891-022-05357-y获得。
To evaluate the relative performance of clinical readouts including serum C-reactive protein (CRP) levels, the erythrocyte sedimentation rate (ESR), globulin (GLB) levels, the albumin to GLB ratio (A/G), and the neutrophil to lymphocyte ratio (NLR) when diagnosing periprosthetic joint infection (PJI). Clinical data was collected from 115 individuals diagnosed in our department between January 2017 and December 2020 with either chronic PJI (29 female, 24 male; median age 71.00 years [range, 41–94 years]) or aseptic loosening (30 female, 32 male; median age 68.50 years [range, 34–85 years]). Patient demographic data were compared, and the relative sensitivity and specificity of preoperative GLB, ESR, CRP, NLR, and A/G values as predictors of PJI diagnosis were assessed. Median globulin levels in the PJI and aseptic groups were 31.700 g/L (interquartile range [IQR], 28.400—35.300) and 26.600 g/L (IQR, 24.375—30.550), respectively (p < 0.001). The median A/G values in the PJI and aseptic groups were 1.150 (IQR, 0.960—1.255) and 1.510 (IQR, 1.265—1.670), respectively (p < 0.001). The median NLR values in the PJI and aseptic groups were 2.510 (IQR, 1.900—3.335) and 1.850 (IQR, 1.425 to 2.362), respectively (p < 0.001). The median ESR values in the PJI and aseptic groups were 53.000 mm/h (IQR, 35.000—76.500) and 16.000 mm/h (IQR, 7.000—33.000), respectively (p < 0.001). Median CRP levels in the PJI and aseptic groups were 24.890 mg/L (IQR, 10.595—54.095) and 2.245 mg/L (IQR, 0.865—8.6075), respectively (p < 0.001). Area under the receiver operating characteristic (ROC) curve (AUC) values for CRP, ESR, GLB, A/G, and NLR were 0.841 (95% confidence interval, 0.761–0.903), 0.850 (0.771–0.910), 0.747 (0.658–0.824), 0.779 (0.692–0.851), and 0.708 (0.616–0.789), respectively. When GLB > 26.6 g/L, A/G < 1.32, and NLR > 2.1 were utilized as threshold values to diagnose PJI, GLB and A/G were found to exhibit superior sensitivity (90.57%, 81.13%) to that observed for CRP (71.70%) and ESR (79.25%), but the specificity of these two metrics (GLB: 51.61%, A/G: 72.58%) was significantly reduced relative to that for CRP (87.10%) or ESR (75.81%). ROC analyses further revealed that NLR did not exhibit significant advantages in sensitivity (73.58%) or specificity (70.97%) relative to CRP or ESR. Globulin levels, NLR values, and A/G values do not outperform ESR or CRP levels when used to diagnose PJI. The online version contains supplementary material available at 10.1186/s12891-022-05357-y.
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