Synovial fluid α defensin has comparable accuracy to synovial fluid white blood cell count and polymorphonuclear percentage for periprosthetic joint infection diagnosis.
| Autor: | Ivy MI; Mayo Clinic, Rochester, Minnesota, USA., Sharma K; Mayo Clinic, Rochester, Minnesota, USA., Greenwood-Quaintance KE; Mayo Clinic, Rochester, Minnesota, USA., Tande AJ; Mayo Clinic, Rochester, Minnesota, USA., Osmon DR; Mayo Clinic, Rochester, Minnesota, USA., Berbari EF; Mayo Clinic, Rochester, Minnesota, USA., Mandrekar J; Mayo Clinic, Rochester, Minnesota, USA., Beauchamp CP; Mayo Clinic, Phoenix, Arizona, USA., Hanssen AD; Mayo Clinic, Rochester, Minnesota, USA., Abdel MP; Mayo Clinic, Rochester, Minnesota, USA., Lewallen DG; Mayo Clinic, Rochester, Minnesota, USA., Perry K; Mayo Clinic, Rochester, Minnesota, USA., Block DR; Mayo Clinic, Rochester, Minnesota, USA., Snyder MR; Mayo Clinic, Rochester, Minnesota, USA., Patel R; Mayo Clinic, Rochester, Minnesota, USA. |
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| Jazyk: | angličtina |
| Zdroj: | The bone & joint journal [Bone Joint J] 2021 Jun; Vol. 103-B (6), pp. 1119-1126. |
| DOI: | 10.1302/0301-620X.103B6.BJJ-2020-1741.R1 |
| Abstrakt: | Aims: The aim of this study was to determine the diagnostic accuracy of α defensin (AD) lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) tests for periprosthetic joint infection (PJI) in comparison to conventional synovial white blood cell (WBC) count and polymorphonuclear neutrophil percentage (PMN%) analysis. Methods: Patients undergoing joint aspiration for evaluation of pain after total knee arthroplasty (TKA) or total hip arthroplasty (THA) were considered for inclusion. Synovial fluids from 99 patients (25 THA and 74 TKA) were analyzed by WBC count and PMN% analysis, AD LFA, and AD ELISA. WBC and PMN% cutoffs of ≥ 1,700 cells/mm 3 and ≥ 65% for TKA and ≥ 3,000 cells/mm 3 and ≥ 80% for THA were used, respectively. A panel of three physicians, all with expertise in orthopaedic infections and who were blinded to the results of AD tests, independently reviewed patient data to diagnose subjects as with or without PJI. Consensus PJI classification was used as the reference standard to evaluate test performances. Results were compared using McNemar's test and area under the receiver operating characteristic curve (AUC) analysis. Results: Expert consensus classified 18 arthroplasies as having failed due to PJI and 81 due to aseptic failure. Using these classifications, the calculated sensitivity and specificity of AD LFA was 83.3% (95% confidence interval (CI) 58.6 to 96.4) and 93.8% (95% CI 86.2 to 98.0), respectively. Sensitivity and specificity of AD ELISA was 83.3% (95% CI 58.6 to 96.4) and 96.3% (95% CI 89.6 to 99.2), respectively. There was no statistically significant difference between sensitivity (p = 1.000) or specificity (p = 0.157) of the two AD assays. AUC for AD LFA was 0.891. In comparison, AUC for synovial WBC count, PMN%, and the combination of the two values was 0.821 (sensitivity p = 1.000, specificity p < 0.001), 0.886 (sensitivity p = 0.317, specificity p = 0.011), and 0.926 (sensitivity p = 0.317, specificity p = 0.317), respectively. Conclusion: The diagnostic accuracy of synovial AD for PJI diagnosis is comparable and not statistically superior to that of synovial WBC count plus PMN% combined. Cite this article: Bone Joint J 2021;103-B(6):1119-1126. |
| Databáze: | MEDLINE |
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