Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection.
Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection.
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DOI：
10.1186/s12891-020-03704-5
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发表时间：
2020-10-27
影响因子：
2.3
通讯作者：
Chen JY
中科院分区：
文献类型：
--
作者：
Yu BZ;Fu J;Chai W;Hao LB;Chen JY
假体周围关节感染(PJI)是全膝关节或全髋关节置换术后的灾难性并发症。PJI的诊断非常困难，尤其是在术后早期。中性粒细胞/淋巴细胞比率(NLR)对感染性疾病的诊断有一定价值。本研究的目的是探讨NLR对全膝关节或髋关节置换术后早期PJI诊断的准确性。我们回顾了2011年1月至2018年10月连续的初次全膝关节或全髋关节置换术，并确定了在术后90 内再次入院的患者。比较两组患者血清C反应蛋白(CRP)、血沉(ESR)、白细胞计数(WBC)、中性粒细胞受体(NLR)和白细胞介素6(IL-6)的变化。生成接收器工作特性曲线以估计每个参数的最佳截止值。计算各参数的敏感度、特异度、阳性预测值和阴性预测值。感染组的CRP、ESR、WBC、NLR和IL-6均显著高于未感染组。感染组C反应蛋白中位数为66.6 mg/L，非感染组中位数为8.6 mg/L(p <； 0.001)。血沉中位数为34.8 mm/h。感染组为17.4 mm/h。未感染组(p <； 0.001)。感染组和未感染组的白细胞中位数分别为8.2×109/L和6.1×109/L(p = 0.002)，中性粒细胞受体的中位数分别为5.2和2.1(p <； 0.001)。IL-6的中位数分别为46 pg/ml和6.4 pg/ml(p <； 0.001)。早期诊断的最佳指标是IL-6(AUC = 0.814)，其次是中性粒细胞受体(AUC=0.802)、C反应蛋白(AUC=0.793)、血沉(AUC=0.744)和白细胞(AUC = 0.632)。本研究首次证明NLR值比CRP更准确，可作为诊断早期PJI的有用参数，因为它是一种在日常实践中无需额外费用即可计算的廉价且方便的参数。
Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6 mg/l in the uninfected group (p < 0.001). The median of ESR was 34.8 mm/hr. in the infected group and 17.4 mm/hr. in the uninfected group (p < 0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p < 0.001). The median of IL-6 was 46 pg/ml and 6.4 pg/ml (p < 0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632). This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.
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