The Leukocyte Esterase Strip Test has Practical Value for Diagnosing Periprosthetic Joint Infection After Total Knee Arthroplasty: A Multicenter Study

Koh, In Jun; Han, Seung Beom; In, Yong; Oh, Kwang-Jun; Lee, Dae H; Kim, Tae Kyoung

doi:10.1016/j.arth.2017.06.008

Cited by 33 publications

(15 citation statements)

References 29 publications

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“…The original report on the utility of LE by Parvizi et al [6] found that a (þþ) LE cutoff provided 80.6% sensitivity in diagnosing PJI. Although there are a few centers reporting a higher sensitivity for the urinary LE test strip [10,11], most centers have reported lower values, including sensitivities of 69% [5], 66% [9], 81% [1], 84.21% [2], 75% [3], and 84% [4]. A recent large retrospective study of tests for PJI including the erythrocyte sedimentation rate, C-reactive protein, WBC count, polymorphonuclear neutrophil percentage, and LE found that LE had the lowest sensitivity of all tests [3].…”

Section: Discussionmentioning

confidence: 99%

The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection

Deirmengian

Liang

Rosenberger

et al. 2018

The Journal of Arthroplasty

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This study agrees with the existing literature demonstrating that the LE test strips are among the lowest sensitivity tests for PJI. The urinary LE tests strips should not be used to rule-out PJI, as they often fail to detect abundant levels of LE in synovial fluid. Instead, it is more appropriate to use the (++) LE test strip result as a secondary confirmatory rule-in test for PJI because of its high specificity.

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Section: Discussionmentioning

confidence: 99%

The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection

Deirmengian

Liang

Rosenberger

et al. 2018

The Journal of Arthroplasty

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“…CRP and ESR are supported by strong evidence a useful "ruling out" tests [18,19]. Synovial uid tests such as leukocyte count and neutrophil percentage, leukocyte esterase, α-defensin, cultures, and next-generation sequencing for microorganism can play an important diagnostic role [20][21][22]. If preoperative evaluation with serum and synovial uid tests does not secure a diagnosis, then the frozen section tissue histopathology may help make the diagnosis [23].…”

Section: Discussionmentioning

confidence: 99%

Mildly decreased preoperative bilirubin levels are considered as risk factors for periprosthetic joint infection after total hip and knee arthroplasty

Chen

et al. 2020

Preprint

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Background and Purpose Many blood biomarkers are routinely assessed before joint arthroplasty, but only few are commonly used to guide surgeons in determining patients most at risk of periprosthetic joint infection (PJI). The objective of this study was to investigate the correlation between preoperative bilirubin level and PJI after hip and knee arthroplasty. Methods A retrospective analysis was performed on patients undergoing revision hip and knee arthroplasty at our hospital from January 2016 to December 2019. Laboratory biomarkers were collected before the primary arthroplasty, as well as general patient information. The correlation between the above blood biomarkers and postoperative PJI was analyzed. Results A total of 72 patients (30 hips/42 knees) were analyzed, including 39 patients with PJI and 33 patients without PJI. Except for total bilirubin (TB) and direct bilirubin (DB), there was no significant difference between the remaining laboratory biomarkers. The preoperative TB and DB in the PJI group were 10.84 ± 0.61 µmol/L and 3.07 ± 0.19 µmol/L, respectively, which were lower than those in the non-PJI group (14.68 ± 0.75 µmol/L and 4.70 ± 0.39 µmol/L, p = 0.0001 and 0.0002). The AUC of preoperative TB to predict PJI was 0.7552 (p = 0.0002, cutoff = 11.55 µmol/L, sensitivity = 66.67%, specificity = 75.76%, PPV = 76.47%, NPV = 65.79%). Meanwhile, the AUC of preoperative DB was 0.7603 (p = 0.0001, cutoff = 4.00 µmol/L, sensitivity = 84.62%, specificity = 54.45%, PPV = 68.75%, NPV = 75%). Conclusions The serum levels of TB and DB before the primary arthroplasty of PJI patients were lower than those non-PJI patients, and the preoperative values lower than 11.55 µmol/L and 4.00 µmol/L could be considered as risk factors for postoperative PJI.

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“…Leukocyte esterase (LE) strip test has been used to detect urinary tract infections and was first applied to the diagnosis of PJI by Parvizi et al in 2011 [3]. Since then, several studies evaluated the diagnostic efficiency of the LE strip [4][5][6]. However, cases with inflammatory arthritis were always excluded in previous studies, which evaluated the diagnostic efficiency of the LE strip for PJI [7], and thus, the influence of inflammatory arthritis has not been well explored.…”

Section: Introductionmentioning

confidence: 99%

Influence of inflammatory arthritis on leukocyte esterase strip results in the diagnosis of periprosthetic joint infection

et al. 2020

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Background: The leukocyte esterase (LE) strip is considered as a helpful method to detect infection, which might be influenced by other inflammatory diseases. This study aims to explore whether the centrifugation of synovial fluid could influence the positive result of LE strip caused by inflammatory arthritis during the diagnosis of periprosthetic joint infection (PJI). Methods: From March 2016 to December 2018, 64 patients who were diagnosed as PJI or aseptic arthritis and another 20 patients with inflammatory arthritis were enrolled in our study. After synovial fluid samples were obtained, the LE strip test was performed with and without centrifugation. Then clinicians read the color changes 3 min after the samples were dropped and classify the results based on the instruction of strip. The differences between septic and aseptic arthritis patients and septic and inflammatory arthritis patients were analyzed. Results: Among the included 21 PJI samples, 19 of them showed positive results (++) of LE strip before centrifugation. After centrifugation, two samples changed from two-positive (++) to one-positive (+), which is also considered as positive. Before centrifugation, 29 of the LE strip tests in the aseptic arthritis group (43 samples included) were ++ or +. After centrifugation, 16 of the samples yielded negative results. Among 20 samples with inflammatory arthritis, LE strip of 18 samples were positive (++ or +) before centrifugation, among which only 3 samples remained as positive after centrifugation. Conclusion: LE strip test results could be influenced by inflammatory arthritis during the diagnosis of PJI. Centrifugation should be performed for LE strip tests to determine whether the result is a true positive or a false positive influenced by inflammatory arthritis.

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The Leukocyte Esterase Strip Test has Practical Value for Diagnosing Periprosthetic Joint Infection After Total Knee Arthroplasty: A Multicenter Study

Cited by 33 publications

References 29 publications

The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection

The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection

Mildly decreased preoperative bilirubin levels are considered as risk factors for periprosthetic joint infection after total hip and knee arthroplasty

Influence of inflammatory arthritis on leukocyte esterase strip results in the diagnosis of periprosthetic joint infection

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