The Potential Value of Monocyte to Lymphocyte Ratio, Platelet to Mean Platelet Volume Ratio in the Diagnosis of Periprosthetic Joint Infections

Abstract

Objective: To explore the possibility of obtaining more accurate information from routine blood tests for the diagnosis of periprosthetic joint infection (PJI).Methods: This is a retrospective study. Between 2017 and 2018, a total of 246 patients who underwent total hip or knee revision surgery were included in this study. There were 146 females and 100 males, and the mean age of the patients was 62.1 AE 12.75 years. Laboratory parameters erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, plasma fibrinogen, serum white blood cell (WBC), and calculable ratio markers were collected. Based on leukocytes (monocyte count, neutrophil count, lymphocyte count), platelet count, and mean platelet volume Inflammation-related ratio markers were calculated, which including monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and platelet to mean platelet volume ratio (PMR). Follow-up of all studied cases for at least 1 year. The diagnostic value of the markers based on the receiver operating characteristic (ROC) analysis. The most optimal combinations of blood markers were selected by the prediction models. Statistical analyses and prediction models were performed using R software.Results: Of the 246 patients, 125 were diagnosed with PJI and 121 with aseptic loosening. A higher rate of patients underwent revision surgery due to hip prosthesis loosening in the aseptic loosening group (74.4%) compared to the PJI group (45.6%, P < 0.001). ROC curves showed that the area under the curve (AUC) for classical markers, fibrinogen was 0.853 (95% confidence interval [CI], 0.805-0.901), ESR was 0.836 (95% CI, 0.785-0.887) and CRP was 0.825 (95% CI, 0.773-0.878). Followed by the PMR, PLR, NLR and MLR, which showed promising diagnostic performance with AUCs of 0.791, 0.785, 0.736, and 0.733. The AUCs of the ratio markers were higher than those of D-dimer (0.691;95% CI, 0.6243-0.7584) and serum WBC (0.622; 95% CI, 0.552-0.691). After the predictive model calculation, AUC was up to 0.923 (95% CI, 0.891-0.951) when plasma fibrinogen combined with MLR and PMR and interpreted excellent discriminatory capacity with a sensitivity of 86.40% and a specificity of 84.17%. The new combination significantly increases the accuracy and reliability of the diagnosis of PJI (P < 0.001). The AUC increased to 0.899 (95% CI, 0.861-0.931; P = 0.007) and 0.916 (95% CI, 0.880-0.946; P < 0.001), followed by CRP and ESR, respectively. All plasma fibrinogen, ESR, and CRP combined with both PMR and MLR achieved the highest specificity (89.17%) and PPV (85.34%). Conclusion:The diagnostic performance greatly improved when plasma fibrinogen, ESR, and CRP combined with ratio markers.

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

“…The remaining 11 articles were included in our meta-analysis. These included articles were retrospective investigations [ 22 , 23 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Table 1 summarizes the characteristics of the studies.…”

“…The site of PJI was reported in all studies involving patients affected by hip or knee prosthetic infections. Only three articles analyzed all four parameters [ 22 , 42 , 47 ] and all the included articles gave their cut-offs for discriminating PJI and aseptic failures for the analyzed ratios. The results of the QUADAS-2 assessment for each study are provided in Table 2 .…”

“…This parameter has been analyzed in four of the eleven included articles [ 22 , 42 , 46 , 47 ]. One thousand seven hundred ninety-one patients with a percentage of PJI of 43% (767/1791) were evaluated.…”

“…Neutrophil-to-lymphocyte ratio has been analyzed in all of the included studies [ 22 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] but one [ 23 ]. The number of patients included in these studies is 2600, with a percentage of PJI of 39% (1025/2600).…”

“…Platelet-to-mean platelet volume ratio has been studied in five articles [ 22 , 23 , 42 , 45 , 47 ]. The number of patients included in these studies is 6363, with a percentage of PJI of 24% (1546/6363).…”