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International Orthopaedics

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Open Access 01-12-2020 | Joint Infection | Original Paper

Combined serum biomarker analysis shows no benefit in the diagnosis of periprosthetic joint infection

Authors: S. M. Klim, F. Amerstorfer, G. Glehr, G. Hauer, M. A. Smolle, L. Leitner, A. Leithner, M. Glehr

Published in: International Orthopaedics | Issue 12/2020

Abstract

Purpose

In many cases, the diagnosis of a periprosthetic joint infection (PJI) consisting of the clinical appearance, laboratory tests, and other diagnostic tools remains a difficult task. Single serum biomarkers are easy to collect, are suitable for periodical assessment, and are a crucial tool in PJI diagnosis, but limited sensitivity or specificity is reported in literature. The aim of this study was to combine the best-performing single serum biomarkers into a multi-biomarker model aiming to improve the diagnostic properties.

Methods

Within a 27-month period, 124 surgical procedures (aseptic or septic revision total knee arthroplasty (TKA) or total hip arthroplasty (THA)) were prospectively included. The serum leukocyte count, C-reactive protein (CRP), interleukin-6, procalcitonin, interferon alpha, and fibrinogen were assessed 1 day prior to surgery. Logistic regression with lasso-regularization was used for the biomarkers and all their ratios. After randomly splitting the data into a training (75%) and a test set (25%), the multi-biomarker model was calculated and validated in a cross-validation approach.

Results

CRP (AUC 0.91, specificity 0.67, sensitivity 0.90, p value 0.03) and fibrinogen (AUC 0.93, specificity 0.73, sensitivity 0.94, p value 0.02) had the best single-biomarker performances. The multi-biomarker model including fibrinogen, CRP, the ratio of fibrinogen to CRP, and the ratio of serum thrombocytes to CRP showed a similar performance (AUC 0.95, specificity 0.91, sensitivity 0.72, p value 0.01).

Conclusion

In this study, multiple biomarkers were tested for their diagnostic performance, with CRP and fibrinogen showing the best results regarding the AUC, accuracy, sensitivity, and specificity. It was not possible to further increase the diagnostic accuracy by combining multiple biomarkers using sophisticated statistical methods.

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Title: Combined serum biomarker analysis shows no benefit in the diagnosis of periprosthetic joint infection
Authors: S. M. Klim
F. Amerstorfer
G. Glehr
G. Hauer
M. A. Smolle
L. Leitner
A. Leithner
M. Glehr
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Joint Infection
Biomarkers
Hip-TEP
Hip-TEP
Published in: International Orthopaedics / Issue 12/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04731-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combined serum biomarker analysis shows no benefit in the diagnosis of periprosthetic joint infection

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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