Diagnostic accuracy of synovial fluid D-lactate for periprosthetic joint infection: a systematic review and meta-analysis

Li, Zhizhuo; Li, Chang-Jiu; Wang, Guangxue; Shi, Lijun; Li, Tengqi; Fan, Xiaoyu; Xu, Xin; Wang, Peixu; Gao, Fuqiang; Sun, Wei

doi:10.1186/s13018-021-02778-8

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…In accordance with the Musculoskeletal Infection Society criteria for PJI, they reported a sensitivity of 94.3% and specificity of 78.4%. Finally, Li et al [16] summarized the results of five studies and concluded that D-lactic acid has potential value in the diagnosis of PJI, with 82% sensitivity and 76% specificity. They suggested the concentration of D-lactic acid likely reflects the virulence of bacteria and microbial load.…”

Section: Discussionmentioning

confidence: 99%

“…The need to perform rapid diagnostics in the outpatient clinic or operating room intraoperatively prompted us to conduct research on a rapid test that detects D-lactic acid based on the promising results of laboratory tests [11,28]. The utility of D-lactic acid in diagnosing a native joint infection and PJIs was recently investigated with laboratory ELISA tests with good results [7,11,16,28]. However, the effectiveness of commercially available, rapid, semiquantitative strip tests that can diagnose PJI has not, to our knowledge, been examined.…”

Section: Introductionmentioning

confidence: 99%

“…Future studies should ask, what is the cause of these differences, including the test type (rapid strip versus laboratory) and accuracy of the test, method of reading (manual versus automatic), and the application of the diagnostic standard (such as ICM 2018 criteria, Musculoskeletal Infection Society criteria, institutional criteria, or European Bone and Joint Infection Society criteria for PJI). Li et al[16] summarized the results of five studies and concluded that D-lactic acid has potential value in the diagnosis of PJI, with 82% sensitivity and 76% specificity.…”

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confidence: 99%

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What is the Accuracy of a Rapid Strip Test That Detects D-lactic Acid in Synovial Fluid for the Diagnosis of Periprosthetic Joint Infections?

Grzelecki¹,

Grajek²,

Walczak³

et al. 2022

Clin Orthop Relat Res

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BackgroundD-lactic acid is a specific marker produced almost exclusively by bacterial species; thus, the appearance of this marker in synovial fluid may indicate periprosthetic joint infection (PJI). Recently, studies have investigated the accuracy of enzyme-linked laboratory tests that detect D-lactic acid in synovial fluid to diagnose PJI. However, to our knowledge, no studies have determined the usefulness of rapid strip tests that detect D-lactic acid in synovial fluid in the diagnosis of PJI.Questions/purposes(1) What is the best cutoff value for the rapid D-lactic acid strip test for diagnosing PJI? (2) What are the diagnostic accuracies (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of the rapid D-lactic acid strip test and two different rapid leukocyte esterase (LE) strip tests?MethodsThis prospective study enrolled 157 patients who underwent revision THA or TKA from May 2021 to February 2022 at a single orthopaedic center. Seventy percent (110 of 157) were eligible for analysis; 10% of these patients (15 of 157) were excluded based on the exclusion criteria (causes of revisions and additional comorbidities that may interfere with the results), and 20% (32 of 157) of the synovial fluid samples could not be tested (dry taps and blood-contaminated samples that could not be centrifuged). We performed the following off-label diagnostic tests on synovial fluid samples collected from all patients: the D-lactic acid strip test (QuantiQuickTM, BioAssay System), two different LE strip tests (10 EA from ARKRAY and BM 10 from BioMaxima). Differently colored strips were marked with symbols (from [-] to [++++] for D-lactic acid and from [-] to [+++] for LE tests) according to the manufacturers’ instructions. For the LE tests, results were different for (++), which corresponds to a minimal value of 250 leu/mL for 10 EA and 125 leu/mL for BM 10 tests. The diagnostic standard for the presence or absence of PJI in this study was the International Consensus Meeting (ICM) 2018 criteria; based on these criteria (without the application of an LE test as a minor criterion), all patients were assessed and divided into two groups. Patients who did not meet the criteria for PJI and underwent revision for aseptic loosening, implant malposition, instability, or implant damage were included in the aseptic revision total joint arthroplasty group (68 patients). Patients with a fistula penetrating the joint, those with two positive culture results of the same pathogen, or those with ≥ 6 points according to ICM 2018 minor criteria were enrolled in the PJI group (42 patients). To ascertain the best cutoff value for the rapid D-lactic acid and both LE strip tests for diagnosing PJI, we used collected results, generated a receiver operating characteristic curve, and calculated the Youden index. To determine the accuracies of the diagnostic tests, we calculated their sensitivities, specificities, PPVs, and NPVs against the diagnostic standard (the ICM 2018 criteria).ResultsThe best cu...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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What is the Accuracy of a Rapid Strip Test That Detects D-lactic Acid in Synovial Fluid for the Diagnosis of Periprosthetic Joint Infections?

Grzelecki¹,

Grajek²,

Walczak³

et al. 2022

Clin Orthop Relat Res

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“…The sensitivity of synovial fluid D-lactate was found to be 92.4%–94.3% with a specificity ranging from 78.4%–88.6% for the respective definition criteria. Li et al conducted a meta-analysis to evaluate the diagnostic accuracy of D-lactate for PJI in which 5 studies were included ( 32 ). The pooled sensitivity and specificity of D-lactate for the diagnosis of PJI were 82% and 76%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Temat zakażeń okołoprotezowych stale się rozwija, ze względu na to że dąży się do uzyskania uniwersalnego i idealnego algorytmu diagnostycznego, dlatego cały czas się prowadzi badania, poszukując idealnego markera, który mógłby skrócić czas poświęcany diagnostyce i obniżyć jej koszty. Doniesienia naukowe z czasopism medycznych wskazują, że trwają badania nad skutecznością nowych biomarkerów, a między innymi nad laktoferyną, PRTN3 oraz MNDA [17], poziomem kalprotektyny w płynie stawowym [18], oznaczaniem peptydów w moczu [19] i poziomu D-mleczanów w płynie stawowym [20] są najnowszymi i bardzo obiecującymi kierunkami rozwoju diagnostyki PJI.…”

Section: Podsumowanieunclassified

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

TSITKO

DUDZIŃSKA

MILANOWSKA

et al. 2022

J Educ Health Sport

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Total knee replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the knee joint. Due to the aging of the population and the prevalence of osteoarthritis, the number of arthroplasties is increasing every day. Such extensive surgical procedures are associated with a large number of postoperative complications, one of which is periprosthetic joint infection. The reported prevalence of PJI out to 2 years after knee replacement is 1.55 %. Misconceptions in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The aim of the following article was to provide an overview of the medical knowledge on the periprosthetic joint infection after the arthroplasty of knee joint. Infections are caused by microbes that can enter the joint, which are most often coagulase-negative Staphylococci, Staphylococcus Aureus, Streptococci, Enterococci and Gram-negative bacteria. Fungal infections are much less common. The diagnostic process requires the involvement of a large group of medical personnel, which is why protocols with algorithms have been created to facilitate and standardize the diagnosis in the direction of periprosthetic joint infections. Mainly used tests from the patient's serum, synovial tests and histology. The positive results of the above tests are taken into account in the assessment of the fulfillment of the major and minor criteria to assess the likelihood of the occurrence of periprosthetic infection. This research paper aims to analyze the latest medical reports on the PJI diagnostic algorithm, laboratory and imaging studies of their effectiveness. This article was written based on analyzing data available in publications in Pubmed and Google Scholar databases

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Diagnostic accuracy of synovial fluid D-lactate for periprosthetic joint infection: a systematic review and meta-analysis

Cited by 11 publications

References 22 publications

What is the Accuracy of a Rapid Strip Test That Detects D-lactic Acid in Synovial Fluid for the Diagnosis of Periprosthetic Joint Infections?

What is the Accuracy of a Rapid Strip Test That Detects D-lactic Acid in Synovial Fluid for the Diagnosis of Periprosthetic Joint Infections?

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

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

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