D-lactate is a promising biomarker for the diagnosis of periprosthetic joint infection

Abstract

IntroductionReliable biomarkers for the diagnosis of periprosthetic joint infection (PJI) are of paramount clinical value. To date, synovial fluid leukocyte count is the standard surrogate parameter indicating PJI. As D-lactate is almost solely produced by bacteria, it represents a promising molecule in the diagnostic workflow of PJI evaluation. Therefore, the purpose of this study was to assess the performance of synovial fluid D-lactate for diagnosing PJI of the hip and knee.Materials and MethodsThese are preliminary results of a prospective multicenter study from one academic center. Seventy-two consecutive patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA) were prospectively included. All patients received a joint aspiration in order to rule out or confirm PJI, which was diagnosed according to previously published institutional criteria. Synovial fluid D-lactate was determined spectrophotometrically at 450 nm. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance.ResultsEighteen patients (25%) were diagnosed with PJI and 54 patients (75%) were classified as aseptic. Synovial fluid D-lactate showed a sensitivity of 90.7% (95% CI: 79.7%–96.9%) and specificity of 83.3% (95% CI: 58.6%–96.4%) at a cut-off of 0.04 mmol/L. The median concentration of D-lactate was significantly higher in patients with PJI than in those with aseptic conditions (0.048 mmol/L, range, 0.026–0.076 mmol/L vs. 0.024 mmol/L, range, 0.003–0.058 mmol/L, p < 0.0001). The predominat microogranisms were staphylococci, followed by streptococci and gram-negative bacteria.ConclusionD-lactate bears a strong potential to act as a valuable biomarker for diagnosing PJI of the hip and knee. In our study, a cutoff of 0.04 mmol/L showed a comparable sensitivity to synovial fluid leukocyte count. However, its specificity was higher compared to conventional diagnostic tools. The additional advantages of D-lactate testing are requirement of low synovial fluid volume, short turnaround time and low cost.

Early detection of plasma d-lactate: Toward a new highly-specific biomarker of bacteraemia?

“…In the field of infectious diseases, d -lactate was also occasionally assessed as an early indicator of infection in different matrices, such as cerebrospinal fluid, pleural fluid, ascitic fluid or synovial fluid [ 18 ]. In particular, it was identified as a promising biomarker in a context of bacterial synovitis or periprosthetic joint infections, displaying high sensitivity and specificity [ [19] , [20] , [21] , [22] , [23] ], as recently reviewed through a meta-analysis by Li et al [ 24 ]. Furthermore, d -lactate was identified as a prognosis marker of 28-day mortality in ICU patients admitted in a context of septic shock [ 25 ].…”

Diagnostic Value of Synovial Fluid Biomarkers for Periprosthetic Joint Infection: A Prospective, Double-blind Trial

“…An elevated synovial fluid white blood cell count (SF-WBC), percentage of polymorphonuclear neutrophil (SF-PMN), erythrocyte sedimentation rate (ESR), and serum C-reactive protein (CRP) level have recently been suggested as useful biomarkers for the diagnosis of PJI [ 5 ]. In addition, novel biomarkers with potential diagnostic efficiency for PJI, such as D-lactate [ 6 ], lipocalin-2 [ 7 ], and synovial fluid myeloperoxidase [ 8 ], are also under exploration. Therefore, investigation of novel biomarkers with higher diagnostic efficiency is crucial for the accurate diagnosis of PJI.…”