Diagnostic Performance of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Platelet to Mean Platelet Volume Ratio in Periprosthetic Hip and Knee Infections: A Systematic Review and Meta-Analysis

Abstract

The current literature on the diagnosis of periprosthetic joint infection provides controversial evidence on the diagnostic accuracy of MLR, NLR, PVR, and PLR. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of these biomarkers for the diagnosis of hip and knee prosthetic infection. According to the PRISMA flowchart, we searched MEDLINE, Scopus, and Web of Science, for studies on these ratios for diagnosing PJI. Sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and AUC were analyzed. We included 11 articles in our meta-analysis, including 7537 patients who underwent total hip and knee arthroplasties; among these, 1974 (26%) patients reported a joint infection. The pooled sensitivity and specificity were 0.72 and 0.74, respectively, for NLR, 0.72 and 0.77 for PVR, and 0.77 and 0.75 for PLR. The sensitivity of MLR ranges from 0.54 to 0.81, while the specificity ranges from 0.78 to 0.81. Regarding the evaluation of AUCs, the best diagnostic performance was achieved by MLR (AUC = 0.77) followed by PLR (AUC = 0.75), NLR (AUC = 0.73), and PVR (AUC = 0.70). This meta-analysis demonstrates a fair diagnostic accuracy of these ratios, thus not being useful as a screening tool.

Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty

“…The predictive role of inflammatory biomarkers was analyzed and also demonstrated in the case of periprosthetic joint infection [ 39 , 40 , 41 , 55 , 56 , 57 ]. In the systemic review published by Festa et al [ 39 ], it was demonstrated that high values of MLR, NLR, and PLR are associated with the detection of hip and knee periprosthetic infection.…”

“…Hematological reports, based on neutrophil, monocyte, lymphocyte, and platelets total number: monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), are routine inflammatory biomarkers, easy to use, with low costs. Moreover, the predictive role of these reports has been recently demonstrated in the literature in the case of cardiovascular pathology [ 24 , 25 , 26 , 27 ], pulmonary embolism [ 28 , 29 ], chronic kidney disease [ 30 , 31 , 32 ], the case of COVID-19 patients [ 33 , 34 , 35 , 36 , 37 , 38 ], as well as in the case of peri-prosthetic infection after total joint arthroplasty [ 39 , 40 , 41 ].…”

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial

“…Prosthetic joint infection (PJI) is one of the most severe complications after TKA [32]. Several studies have shown that PJI after knee surgery is associated with higher NRL and PLR levels [33][34][35][36][37]. Golge et al [38] found the value of 2.45 to be a cut-off point for infection after TKA.…”

Current relevance of biomarkers in diagnosis of periprosthetic joint infection: an update

“…These biomarkers, in combination with plasma fibrinogen, ESR and CRP have been shown to increase the diagnostic performance [ 81 ]. Although a recent meta-analysis on the aforementioned ratios has shown a fair diagnostic value, it is not suggested as a screening tool [ 82 ]. More studies are needed to reach a consensus on these biomarkers.…”