Synovial calprotectin is a reliable biomarker for periprosthetic joint infections in acute-phase inflammation — a prospective cohort study

Lazic, Igor; Prodinger, Peter Michael; Stephan, Maximilian; Haug, Andrea; Pohlig, Florian; Langer, Severin; Eisenhart-Rothe, Rüdiger von; Suren, Christian

doi:10.1007/s00264-022-05421-1

Cited by 11 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The application provides a quantitative value of calprotectin and proposes 3 different risk stratifications for the assessment of the risk of PJI [ 44 ]. An additional advantage of this biomarker is its consistent accuracy in the setting of other etiologies for inflammation, including inflammatory arthritis, fracture, dislocation, or recent surgery that may mimic infection [ 45 , 46 ]. The sensitivity of the test has been reported to be at 71%–94% and the specificity at 81%–88%, with a PPV of 71%–77% and an NPV of 76%–98% [ 44 , 45 , 47 ].…”

Section: Overviewmentioning

confidence: 99%

“…An additional advantage of this biomarker is its consistent accuracy in the setting of other etiologies for inflammation, including inflammatory arthritis, fracture, dislocation, or recent surgery that may mimic infection [ 45 , 46 ]. The sensitivity of the test has been reported to be at 71%–94% and the specificity at 81%–88%, with a PPV of 71%–77% and an NPV of 76%–98% [ 44 , 45 , 47 ]. These test kits are not yet widely available in the USA and a specific threshold has not been determined to definitively rule in or out infection.…”

Section: Overviewmentioning

confidence: 99%

See 1 more Smart Citation

Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

Quinlan,

Jennings

2023

Arthroplasty

View full text Add to dashboard Cite

Diagnosing chronic periprosthetic joint infection (PJI) requires clinical suspicion in combination with both serological and synovial fluid tests, the results of which are generally applied to validated scoring systems or consensus definitions for PJI. As no single “gold standard” test exists, the diagnosis becomes challenging, especially in the setting of negative cultures or equivocal test results. This review aims to address the workup of chronic PJI and considerations for clinical evaluation to guide treatment. Following aspiration of the joint in question, a multitude of tests has been developed in an attempt to assist with diagnosis, including cell synovial white blood cell count, gram stain, cultures, leukocyte esterase, alpha-defensin, synovial C-reactive protein, multiplex polymerase chain reaction, next-generation sequencing, and interleukins. Each test has advantages and disadvantages and should be used in conjunction with the overall clinical picture to guide further clinical evaluation and treatment in this complex patient population.

show abstract

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

Quinlan,

Jennings

2023

Arthroplasty

View full text Add to dashboard Cite

show abstract

The synovial fluid calprotectin lateral flow test for the diagnosis of chronic prosthetic joint infection in failed primary and revision total hip and knee arthroplasty

Suren

Lazic

Haller

et al. 2023

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The diagnostic criteria of prosthetic joint infection (PJI) recommended by the most commonly used diagnostic algorithms can be obscured or distorted by other inflammatory processes or aseptic pathology. Furthermore, the most reliable diagnostic criteria are garnered during revision surgery. A robust, reliable addition to the preoperative diagnostic cascade is warranted. Calprotectin has been shown to be an excellent diagnostic marker for PJI. In this study, we aimed to evaluate a lateral flow test (LFT) in the challenging patient cohort of a national referral centre for revision arthroplasty. Methods Beginning in March 2019, we prospectively included patients scheduled for arthroplasty exchange of a total hip (THA) or knee arthroplasty (TKA). Synovial fluid samples were collected intra-operatively. We used the International Consensus Meeting of 2018 (ICM) score as the gold standard. We then compared the pre-operative ICM score with the LFT result to calculate its diagnostic accuracy as a standalone pre-operative marker and in combination with the ICM score as part of an expanded diagnostic workup. Results A total of 137 patients with a mean age of 67 (± 13) years with 53 THA and 84 TKA were included. Ninety-nine patients (72.8%) were not infected, 34 (25.0) were infected, and four (2.9%) had an inconclusive final score and could not be classified after surgery. The calprotectin LFT had a sensitivity (95% confidence interval) of 0.94 (0.80–0.99) and a specificity of 0.87 (0.79–0.93). The area under the receiver operating characteristic curve (AUC) for the calprotectin LFT was 0.94 (0.89–0.99). In nine cases with an inconclusive pre-operative ICM score, the calprotectin LFT would have led to the correct diagnosis of PJI. Conclusions The synovial fluid calprotectin LFT shows excellent diagnostic metrics both as a rule-in and a rule-out test, even in a challenging patient cohort with cases of severe osteolysis, wear disease, numerous preceding surgeries, and poor soft tissue conditions, which can impair the common diagnostic criteria. As it is available pre-operatively, this test might prove to be a very useful addition to the diagnostic algorithm.

show abstract

Synovial calprotectin in prosthetic joint infection. A systematic review and meta-analysis of the literature

Festa,

Ascione,

Di Gennaro

et al. 2024

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction Calprotectin is a protein endowed with antimicrobial properties, rendering it a distinctive marker for infection. Two methods are currently available for the assay of calprotectin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test (LFT). We aimed to assess the diagnostic accuracy of synovial fluid calprotectin and to compare the accuracy of the laboratory-based test and the qualitative assessment for the diagnosis of hip and knee prosthetic infection. Materials and methods We searched (from inception to November 2023) MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane for studies on calprotectin in the diagnosis of periprosthetic joint infection (PJI). Sensitivity, specificity, positive and negative likelihood ratio (LR), and diagnostic odds ratio were analyzed. The receiver-operating curve for each method was calculated. Results We included 14 articles in our meta-analysis, including 902 patients who underwent total hip and knee arthroplasties revision; 331 (37%) had a joint infection according to MSIS, MSIS-modified criteria, ICM 2018 and EBJIS 2021. Considering the false-positive result rate of 6% and false-negative result rate of 7%, pooled sensitivity and specificity were 0.92 (95% CI 0.89–0.94) and 0.93 (0.91–0.95), respectively. The area under the curve (AUC) was 0.93 (95% CI 0.91–0.94). No statistical differences in terms of sensitivity and specificity were found between ELISA and LFT. The pooled sensitivity and specificity of the two calprotectin assessment methods were: LFT 0.90 (95% CI 0.869–0.935) and 0.92 (95% CI 0.894–0.941), respectively; ELISA 0.96 (95% CI 0.914–0.986) and 0.97 (95% CI 0.934–0.988), respectively. The diagnostic odds ratio of the ELISA was superior to that of the LFT (906.6667, 95% CI 271.2686–3030.3712 versus 113.8886, 95% CI 70.4001-184.2414; p < 0.001). The AUC for ELISA and LFT was 0.968 (95% CI 0.944–0.984) and 0.915 (95% CI 0.895–0.933), respectively. Conclusions Detection of synovial calprotectin is an accurate test for diagnosis of hip and knee prosthetic infections. The diagnostic accuracy of the two calprotectin assessment methods is almost comparable. The LFT is a valid, rapid, and more available diagnostic tool, particularly to rule out PJI.

show abstract

Synovial calprotectin is a reliable biomarker for periprosthetic joint infections in acute-phase inflammation — a prospective cohort study

Cited by 11 publications

References 17 publications

Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

Joint aspiration for diagnosis of chronic periprosthetic joint infection: when, how, and what tests?

The synovial fluid calprotectin lateral flow test for the diagnosis of chronic prosthetic joint infection in failed primary and revision total hip and knee arthroplasty

Synovial calprotectin in prosthetic joint infection. A systematic review and meta-analysis of the literature

Contact Info

Product

Resources

About