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Performance of synovial fluid D-lactate for the diagnosis of periprosthetic joint infection: A prospective
Katsiaryna Yermak1, Svetlana Karbysheva2, Carsten Perka1
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, D-13353 Berlin, Germany.
Objectives:
Synovial fluid leukocyte count is the current standard test for diagnosing periprosthetic joint infection (PJI). As D-lactate is almost exclusively produced by bacteria, it represents a useful biomarker for bacterial infection. We evaluated the performance of synovial fluid D-lactate for the diagnosis of PJI and compared it with the synovial fluid leukocyte count.
Methods:
Consecutive patients with joint aspiration of a prosthetic hip, knee or shoulder joint were prospectively included. PJI was diagnosed according to the working criteria of the European Bone and Joint Infection Society (EBJIS). The synovial fluid D-lactate was determined spectrophotometrically at 570 nm, synovial fluid leukocytes were counted by flow cytometry. The receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of investigated parameters.
Results:
Of 148 patients, 44 (30%) were diagnosed with PJI and 104 (70%) with aseptic failure. For diagnosis of PJI, the sensitivity of synovial fluid D-lactate (at cut-off 1.263 mmol/l) was 86.4% [95% CI, 75.0-95.5%] and the specificity was 80.8% [95% CI, 73.1-88.5%]. The AUCs of D-lactate concentration and leukocyte count were 90.3% [95% CI 85.7-95.0%] and 91.0% [95% CI 85.1-96.8%], respectively (p = 0.8). Virulence of the pathogen did not influence the D-lactate concentration (p = 0.123). The synovial fluid erythrocyte concentration correlated with D-lactate in patients with aseptic failure (ρ = 0.339, p <0.01).
Conclusion:
Synovial fluid D-lactate showed similar performance to the leukocyte count for diagnosis of PJI. Advantages of D-lactate test are requirement of low synovial fluid volume, short turnaround time and low cost.
Insights
Synovial fluid D-lactate shows comparable diagnostic performance to leukocyte counts for periprosthetic joint infection (PJI). This D-lactate test offers advantages of low sample volume, rapid results, and cost-effectiveness for PJI diagnosis.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biochemistry
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on synovial fluid leukocyte count.
- D-lactate, a bacterial byproduct, is a potential biomarker for bacterial infections.
Purpose of the Study:
- To evaluate the diagnostic performance of synovial fluid D-lactate for PJI.
- To compare D-lactate's efficacy against synovial fluid leukocyte count in PJI diagnosis.
Main Methods:
- Prospective inclusion of patients undergoing joint aspiration for prosthetic joints.
- Diagnosis of PJI according to European Bone and Joint Infection Society (EBJIS) criteria.
- Spectrophotometric determination of synovial fluid D-lactate and flow cytometry for leukocyte counts.
Main Results:
- D-lactate sensitivity was 86.4% and specificity 80.8% for PJI diagnosis.
- Area Under the Curve (AUC) for D-lactate (90.3%) was comparable to leukocyte count (91.0%).
- Pathogen virulence did not impact D-lactate levels; erythrocyte concentration correlated with D-lactate in aseptic cases.
Conclusions:
- Synovial fluid D-lactate demonstrates similar diagnostic performance to leukocyte count for PJI.
- D-lactate testing offers benefits including minimal sample volume, quick turnaround, and lower cost.
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