An Adjunct Indicator for the Diagnosis of Fracture-Related Infections: Platelet Count to Mean Platelet Volume Ratio

Abstract

Abstract. Introduction: Fracture-related infection (FRI) is a common complication associated with orthopaedic fracture care. Diagnosing these complications in the preoperative setting is difficult. Platelets are a known acute phase reactant with indices that change in accordance with infection and inflammation. The purpose of our study was to assess the diagnostic utility of platelet indices at assessing FRI.Methods: A retrospective review performed for all patients who underwent revision surgery for fracture nonunion between 2013 and 2018. Radiographs were employed to define nonunion. Intraoperative cultures were used to define FRI. Receiver operator characteristic (ROC) curve analysis was used to assess the diagnostic ability of preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and the platelet count/mean platelet volume ratio (P/V) at recognizing FRI.Results: Of the 53 revision surgeries that were performed for fracture nonunion, 17 (32.1%) were identified as FRI. There were no significant demographic differences between the two cohorts. Patients with FRIs exhibited higher values for ESR (54.82 vs. 19.16, p<0.001), CRP (0.90 vs. 0.35, p=0.003), and P/V (37.4 vs. 22.8, p<0.001) as compared to those within the aseptic nonunion cohort. ROC curve analysis for P/V demonstrated that at an optimal ratio of 23, area under the curve (AUC) is 0.814, specificity is 55.6%, and sensitivity is 100.0%. There was no significant difference in the diagnostic performance of the serum biomarkers but only ESR and P/V had an AUC greater than 0.80. The negative predictive value (NPV) for P/V, ESR, and CRP was 100.0%, 84.6%, and 78.6%, respectively.Conclusion: The P/V ratio may serve as a reliable screening test for FRI.

Current Concepts of Fracture-Related Infection

“…In addition to D-dimer, Zhao et al [ 47 ] noted that interleukin-6 (IL-6) had similar diagnostic value for FRI, with comparison to ESR and CRP. Other analyzed indicators for FRI diagnosis included platelet count to mean platelet volume ratio [ 48 ], wound alpha defensin [ 49 ], and cluster of differentiation (CD) 64 [ 50 ]. It is interesting that even altered gut microbiota can be considered as an auxiliary indicator for FRI diagnosis [ 51 ].…”

Different Biomarker Ratios in Peripheral Blood have Limited Value in Diagnosing Periprosthetic Joint Infection after Artificial Joint Replacement：A Single-Center, Retrospective Study

“…17,18 Strony et al reported that the diagnostic accuracy of PVR in patients with fracture-related infection was no less signi cant than that of ESR or CRP, suggesting that PVR could function as an auxiliary diagnostic biomarker of fracture-caused infection. 19 The PLR and NLR have been found to have good diagnostic value for predicting surgical site infection, while the MLR and NLR demonstrate signi cant variation in feverish patients due to bacterial infections. [17][18][19] Based on the above research, a retrospective study conducted by Shi et al revealed that the PLR and NLR in the PJI group were signi cantly greater than those in the aseptic loosening (AL) group.…”

“…19 The PLR and NLR have been found to have good diagnostic value for predicting surgical site infection, while the MLR and NLR demonstrate signi cant variation in feverish patients due to bacterial infections. [17][18][19] Based on the above research, a retrospective study conducted by Shi et al revealed that the PLR and NLR in the PJI group were signi cantly greater than those in the aseptic loosening (AL) group. However, Shi did not evaluate the diagnostic ability of PVR or the MLR for predicting PJI.…”

Different biomarker ratios in peripheral blood have limited value in diagnosing periprosthetic joint infection after total joint arthroplasty: a single-center, retrospective study

“…Recent studies have revealed that changes in the PLR, PVR, NLR and MLR are closely related to inflammatory or infectious status in the body [ 13 , 14 ]. It is reported that the diagnostic accuracy of PVR in patients with fracture-related infection was no less significant than that of ESR or CRP, suggesting that PVR could function as an auxiliary diagnostic biomarker of fracture-caused infection [ 15 ]. The PLR and NLR have been found to have good diagnostic value for predicting surgical site infection, while the MLR and NLR demonstrate significant variation in feverish patients due to bacterial infections [ 13 – 15 ].…”

“…It is reported that the diagnostic accuracy of PVR in patients with fracture-related infection was no less significant than that of ESR or CRP, suggesting that PVR could function as an auxiliary diagnostic biomarker of fracture-caused infection [ 15 ]. The PLR and NLR have been found to have good diagnostic value for predicting surgical site infection, while the MLR and NLR demonstrate significant variation in feverish patients due to bacterial infections [ 13 – 15 ]. A retrospective study also revealed that the PLR and NLR in the PJI group were significantly greater than those in the aseptic loosening (AL) group [ 16 ].…”