Laboratory-based versus qualitative assessment of α-defensin in periprosthetic hip and knee infections: a systematic review and meta-analysis
| Autor: | Vincenzo de Matteo, Cristiano De Franco, Sigismondo Luca Di Donato, Giovanni Balato, Andrea Baldini, Massimo Mariconda, Tiziana Ascione, Francesco Smeraglia |
|---|---|
| Přispěvatelé: | Balato, G., de Matteo, V., Ascione, T., Di Donato, S. L., De Franco, C., Smeraglia, F., Baldini, A., Mariconda, M. |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
alpha-Defensins Prosthetic joint infection Prosthesis-Related Infections Knee Joint Periprosthetic Sensitivity and Specificity Lateral flow test 03 medical and health sciences 0302 clinical medicine Internal medicine Synovial Fluid medicine Humans Orthopedics and Sports Medicine Knee α defensin 030222 orthopedics Hip business.industry Area under the curve 030229 sport sciences General Medicine Meta-analysis Orthopedic surgery Assessment methods Diagnostic odds ratio Surgery Hip Joint Hip Prosthesis α-Defensin business Knee Prosthesis Biomarkers |
| Popis: | 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. 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. 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 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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