Alpha-Defensin versus Leukocyte Esterase in Periprosthetic Joint Infection: An Updated Meta-Analysis

Abstract

Periprosthetic joint infection (PJI) is a devastating complication after arthroplasty. Prompt establishment of an infection diagnosis is critical but can be very challenging at present. In order to evaluate the diagnostic accuracy of alpha-defensin or leukocyte esterase for PJI, we performed systematic research in PubMed, Embase, and Cochrane Library to retrieve relevant studies. Data extraction and quality assessment were performed by two reviewers independently. A total of thirty-one eligible studies were finally included in the quantitative analysis. The pooled sensitivity and specificity of alpha-defensin (21 studies) for the diagnosis of PJI were 0.89 (95% confidence interval (CI), 0.83 to 0.93) and 0.96 (95% CI, 0.95 to 0.97), respectively. The value of the pooled diagnostic odds ratios (DOR) of alpha-defensin for PJI was 209.14 (95% CI, 97.31 to 449.50), and the area under the curve (AUC) was 0.98 (95% CI, 0.96 to 0.99). The pooled sensitivity and specificity of leukocyte esterase (17 studies) for the diagnosis of PJI were 0.90 (95% CI, 0.84 to 0.95) and 0.96 (95% CI, 0.93 to 0.97), respectively. The value of the DOR of leukocyte esterase for PJI was 203.23 (95% CI, 96.14 to 429.61), and the AUC was 0.98 (95% CI, 0.96 to 0.99). Based on the results of our meta-analysis, we can conclude that alpha-defensin and leukocyte esterase are valuable synovial fluid markers for identifying PJI with comparable high diagnostic accuracy.

Fecal Leukocyte Esterase, an Alternative Biomarker to Fecal Calprotectin in Inflammatory Bowel Disease: A Pilot Series

“…25 Similar to calprotectin and lactoferrin, LE activity reflects the presence of white blood cells and has been developed as a rapid, inexpensive, and widely available screening test for bacteriuria. 12,26 Furthermore, LE has potential utility for simple and rapid testing in meningitis and periprosthetic joint infections in adults and spontaneous bacterial peritonitis in adults and children, 7,9,10,[27][28][29][30][31][32][33][34][35][36] offering inexpensive testing alternatives in resourcelimited countries and preventing treatment delay. Recently, Dumoulin et al 26 described the application of LE strip testing in fecal extracts and found a reasonable correlation between FLE and FC.…”

Entzündlich-rheumatische Erkrankungen der Hand jenseits der rheumatoiden Arthritis

“…Bei Endoprothesen ist der Test nicht zuverlässig. Eine sichere Methode zum Infektnachweis ist der Nachweis von α-Defensin im Punktat [17]. Die Gramfärbung erfasst einerseits nur grampositive Erreger und ergibt aufgrund von Verklumpungen des Farbstoffs häufig falsch-positive Ergebnisse.…”

The diagnosis of periprosthetic joint infection after the arthroplasty of knee joint

“…Alfa defensyna jest uwalniana przez neutrofile (PMN) w odpowiedzi na obecnosć́bakterii. Test Synovasure PJI wykazuje 97 % czułości oraz 96 % specyficzności [7,13].…”

“…Jest to enzym produkowany w neutrofilach w obecności patogenów [13]. Przeprowadzenie tego testu jest utrudnione ze względu na konieczność nieobecności krwi w probówce, ponieważ zaburza to odczyt testu.…”