Laboratory-based versus qualitative assessment of α-defensin in periprosthetic hip and knee infections: a systematic review and meta-analysis.

Autor: Balato G; Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Via S. Pansini 5, 80131, Naples, Italy. giovannibalato@gmail.com., de Matteo V; Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Via S. Pansini 5, 80131, Naples, Italy., Ascione T; Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy., Di Donato SL; Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Via S. Pansini 5, 80131, Naples, Italy., De Franco C; Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Via S. Pansini 5, 80131, Naples, Italy., Smeraglia F; Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Via S. Pansini 5, 80131, Naples, Italy., Baldini A; IFCA Institute, Florence, Italy., Mariconda M; Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Via S. Pansini 5, 80131, Naples, Italy.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2020 Mar; Vol. 140 (3), pp. 293-301. Date of Electronic Publication: 2019 Jul 12.
DOI: 10.1007/s00402-019-03232-5
Abstrakt: Introduction: Two methods are currently available for the assay of α-defensin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test. We aimed to assess the diagnostic accuracy of synovial fluid α-defensin and to compare the accuracy of the laboratory-based test and the qualitative assessment for the diagnosis of hip and knee prosthetic infection.
Materials and Methods: We searched (from inception to May 2018) MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane for studies on α-defensin in the diagnosis of periprosthetic joint infection (PJI). Sensitivity, specificity, positive and negative likelihood ratio (LR), and diagnostic odds ratio were analyzed using the bivariate diagnostic random-effects model. The receiver-operating curve for each method was calculated.
Results: We included 13 articles in our meta-analysis, including 1170 patients who underwent total hip and knee arthroplasties revision; 368 (31%) had a joint infection according to MSIS and MSIS-modified criteria. Considering the false-positive result rate of 8% and false-negative result rate of 3%, pooled sensitivity and specificity were 0.90 (95% CI 0.83-0.94) and 0.95 (0.92-0.96), respectively. The area under the curve (AUC) was 0.94 (0.92-0.94). No statistical differences in terms of sensitivity and specificity were found between the laboratory-based and qualitative test. The pooled sensitivity and specificity of the two alpha-defensin assessment methods were: laboratory-based test 0.97 (95% CI 0.93-0.99) and 0.96 (95% CI 0.94-0.98), respectively; qualitative test 0.83 (95% CI 0.73-0.91) and 0.94 (95% CI 0.89-0.97), respectively. The diagnostic odds ratio of the α-defensin laboratory based was superior to that of the qualitative test (1126.085, 95% CI 352.172-3600.702 versus 100.9, 95% CI 30.1-338.41; p < 0.001). The AUC for immunoassay and qualitative tests was 0.97 (0.95-0.99) and 0.91 (0.88-0.99), respectively.
Conclusion: Detection of α-defensin is an accurate test for diagnosis of hip and knee prosthetic infections. The diagnostic accuracy of the two alpha-defensin assessment methods is comparable. The lateral flow assay is a valid, rapid, and more available diagnostic tool, particularly to rule out PJI.
Databáze: MEDLINE
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