Globulin and Albumin To Globulin Ratio Precisely Diagnose Periprosthetic Joint Infection and Determine The Timing of Second-Stage Reimplantation

Abstract

Background Periprosthetic joint infection (PJI) is one of the most challenging complication of total joint arthroplasty (TJI). An early and accurate diagnosis of PJI is associated with better treatment outcomes. However, whether the platelet-related markers and globulin-related markers can be used to assist the diagnosis of PJI remains elusive. Methods 206 patients underwent revision hip or knee arthroplasty in our institution were divided into two groups: 79 patients in PJI group and 127 patients in aseptic failure group. The levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet-related markers including platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT) and PLT to MPV raito (PMR) and globulin-related markers, such as globulin, albumin to globulin ratio (AGR), and PLT to AGR ratio were compared. The diagnostic value was measured using area under the curve (AUC) after constructing receiver operating characteristic (ROC) curves. The potential of each marker for determining the timing of second-staged reimplantation was also evaluated. Results Significantly increased levels of ESR, CRP, PLT, PCT, PMR, GLB, and PLT to AGR ratio were identified in PJI group, while decreased levels of MPV and AGR were also found. The diagnostic values of all platelet-related markers and GLB were considered as fair, and good diagnostic values of AGR and PLT to AGR ratio were found, which were comparable to those of ESR and CRP. The levels of GLB and AGR can also be used to predict negative culture result and the timing of second-stage reimplantation. Conclusions Globulin and albumin to globulin ratio were found to have good diagnostic values for PJI, and they can precisely predict the culture results and persistent infection.

Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review

“…1, and the QUADAS‐2 score criteria revealed that most of the extracted studies had high risks. Excluding brand new markers that only appeared recently and have limited data, 129 records reported diagnostic information of serum markers (serum CRP, ESR, procalcitonin, IL‐6, D‐Dimer, WBC, platelet count [PLT], neutrophil to lymphocyte ratio [NLR], monocyte to lymphocyte ratio [MLR], platelet to lymphocyte ratio [PLR], platelet to mean platelet volume ratio [PVR], FDP [fibrin degradation product] and Fibrinogen), 9–11,24–149 114 studies reported synovial markers (synovial WBC, PMN%, IL‐6, IL‐1β, CRP, TNF‐α, Calprotectin, and leucocyte esterase [LE] and laboratory or lateral‐flow based α‐defensin test),…”