Diagnostic Value of Synovial White Blood Cell Count and Serum C-Reactive Protein for Acute Periprosthetic Joint Infection After Knee Arthroplasty
Diagnostic Value of Synovial White Blood Cell Count and Serum C-Reactive Protein for Acute Periprosthetic Joint Infection After Knee Arthroplasty
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DOI：
10.1016/j.arth.2017.07.013
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发表时间：
2017-12-01
影响因子：
3.5
通讯作者：
Bae, Ji-Hoon
中科院分区：
文献类型：
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作者：
Kim, Sang-Gyun;Kim, Jae-Gyoon;Bae, Ji-Hoon
背景：假体周围关节感染(PJI)的诊断仍然很困难，尤其是在术后急性期。本研究旨在探讨滑液白细胞计数、多形核细胞百分比、血沉和C反应蛋白在膝关节置换术后早期感染诊断中的最佳界值。方法：回顾分析2006年1月至2016年11月首次行全膝关节置换术和单室置换术，术后3周内抽吸膝关节。12例感染病例和185例非感染病例符合本研究的纳入标准。我们比较了两组的实验室参数(滑膜WBC计数、多形核细胞百分比、血沉和C反应蛋白水平)。构建了接收器工作特性曲线，以确定每个参数的最佳截止值。结果：滑膜WBC计数和CRP水平有2个最佳临界值。以L滑液WBC为11,200个/亩时，诊断急性PJI的敏感性(100%)和特异性(98.9%)最高，以16,000个/亩L为最佳，PPV为100%，NPV为99.5%。同样，CRP34.9 mg/L的敏感性(100%)和特异性(90.3%)最好，而CRP74.5 mg/L的PPV(100%)和NPV(99.2%)最好。结论：滑膜WBC计数和CRP值可用于诊断初次膝关节置换术后1~3周的急性PJI。(C)2017 Elsevier Inc.保留所有权利。
Background: The diagnosis of periprosthetic joint infection (PJI) remains difficult, particularly in acute postoperative stage. The purpose of this study was to investigate the optimal cutoff value of synovial white blood cell (WBC) count, percentage of polymorphonuclear cells, erythrocyte sedimentation rate, and C-reactive protein (CRP) for diagnosing early postoperative infection after knee joint arthroplasty.Methods: We retrospectively reviewed primary total knee arthroplasties and unicompartmental knee arthroplasties, with a knee aspiration within 3 weeks of surgery, from January 2006 to November 2016. Twelve infected cases and 185 uninfected cases met the inclusion criteria of our study. We compared the laboratory parameters (synovial WBC count, percentage of polymorphonuclear cells, erythrocyte sedimentation rate, and CRP levels) between the 2 groups. Receiver operating characteristic curves were constructed to determine the optimal cutoff values for each parameter. Each parameter was studied to determine its sensitivity, specificity, and positive and negative predictive values (PPV and NPV) in diagnosing acute PJI.Results: There were 2 optimal cutoff values for synovial WBC count and CRP levels. With the cutoff value of synovial WBC set at 11,200 cells/mu L, acute PJI could be diagnosed with the highest sensitivity (100%) and specificity (98.9%); with the cutoff value set at 16,000 cells/mu L, the best PPV and NPV were found (100% and 99.5%, respectively). Similarly, the CRP level >34.9 mg/L had the best sensitivity (100%) and specificity (90.3%), whereas the CRP level >74.5 mg/L had the best PPV (100%) and NPV (99.2%).Conclusion: Synovial WBC count and CRP levels are useful in diagnosing acute PJI between 1 and 3 weeks after primary knee arthroplasty. (C) 2017 Elsevier Inc. All rights reserved.