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Archives of Orthopaedic and Trauma Surgery

26-12-2023 | Erysipelas | Knee Revision Surgery

What is the diagnostic accuracy of neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio in detecting acute periprosthetic joint infections? A gender-specific analysis

Authors: Taner Karlidag, Mustafa Fatih Dasci, Julian Steinhoff, Thorsten Gehrke, Mustafa Citak

Published in: Archives of Orthopaedic and Trauma Surgery

Abstract

Purpose

The accurate and timely diagnosis of periprosthetic joint infection (PJI) is critical for guiding optimal treatment management and success, highlighting the requirement of readily available inexpensive serum biomarkers to increase the diagnostic accuracy for PJI. Many studies have investigated the diagnostic accuracy of neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR). However, there is a lack of existing literature regarding optimal thresholds for acute PJI. The purpose of this study was to reveal the most appropriate cut-off values for MLR and NLR in detecting acute PJI with a gender specific analysis.

Methods

Patients were classified as having an acute PJI if they met the International Consensus Meeting (ICM) 2018 modified criteria. Patients who had a negative clinical and diagnostic workup for a PJI and the presence of erythema on the index surgical area were included in the erysipelas group (control group). Data obtained from all patients included age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), procedure type (THA or TKA), serum C-reactive protein (CRP), and blood studies at the admission and culture results were retrieved from the electronic medical record.

Results

ROC curve analysis was used to determine the gender-specific optimal threshold values for CRP, NLR, and MLR. Comparing the sensitivities and specificities of NLR and MLR at the identified best thresholds in males and females, the study found similar sensitivities of NLR in males and females with 0.84 and 0.84, respectively. On the other hand, an MLR of 0.67 or more reported a notably higher specificity in male patients [0.90 (95% CI 0.75–0.96) versus 0.70 (95% CI 0.56–0.80)].

Conclusion

NLR and MLR represent commonly ordered, low-cost, simple, and readily available complete cell count laboratory values and should be used as adjunct tests with reasonable diagnostic accuracy in detecting acute PJIs. Moreover, with its excellent specificity and PPV, MLR could provide valuable insight in diagnosing acute PJI, particularly in male patients.

Level of evidence

Level III Retrospective Cohort analysis.

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Title: What is the diagnostic accuracy of neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio in detecting acute periprosthetic joint infections? A gender-specific analysis
Authors: Taner Karlidag
Mustafa Fatih Dasci
Julian Steinhoff
Thorsten Gehrke
Mustafa Citak
Publication date: 26-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Erysipelas
Joint Infection
Published in: Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05162-9

2024 ESC Congress

Springer Medicine

What is the diagnostic accuracy of neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio in detecting acute periprosthetic joint infections? A gender-specific analysis

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

2024 ESC Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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