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Screening for Periprosthetic Joint Infections With ESR and CRP: The Ideal Cutoffs
Joshua S Bingham1, Jeffrey D Hassebrock1, Austin L Christensen2
1Department of Orthopedic Surgery, Mayo Clinic, Arizona, Phoenix, AZ.
Background:
The purpose of this study was to (1) determine the sensitivity and specificity of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) when screening for a periprosthetic joint infection (PJI) using the standard MSIS cutoff of 30 mm/h and 10 mg/L, respectively, and (2) determine the optimal ESR and CRP cutoff to achieve a sensitivity ≥95%.
Methods:
We retrospectively analyzed 81 PJI patients and 83 noninfected arthroplasty patients. We calculated the sensitivity and specificity (and 95% confidence intervals) for ESR and CRP at thresholds of 30 mm/h and 10 mg/L, respectively. We determined the optimal cutoff for both ESR and CRP to yield a sensitivity greater than or equal to 95%.
Results:
The ESR cutoff that resulted in a sensitivity ≥ to 95% (95% CI: 85.2-97.6%) was 10 mm/h, and the CRP cutoff that resulted in a sensitivity ≥ to 95% (95% CI: 87.1-98.4%) was 5 mg/L. The sensitivity and specificity with a combined ESR and CRP of 10 mm/h and 5 mg/L was 100% (95% CI: 94.1-100%) and 54.7% (95% CI: 46.4-62.3%).
Conclusion:
When using ESR and CRP as a screening tool with the accepted cutoffs of 30 mm/h and 10 mg/L, there is an unacceptably low sensitivity and a high number of false negatives. Therefore, further recommendation must be given to lowering these thresholds to avoid the devastating morbidity of a missed PJI.
Level Of Evidence:
III.
Insights
Lowering thresholds for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly improves sensitivity for detecting periprosthetic joint infection (PJI). New cutoffs of 10 mm/h for ESR and 5 mg/L for CRP are recommended for better PJI screening.
Area of Science:
- Orthopedics
- Infectious Diseases
- Clinical Chemistry
Background:
- Periprosthetic joint infection (PJI) is a serious complication after arthroplasty.
- Accurate and sensitive screening tools are crucial for early diagnosis and treatment of PJI.
- Current standard cutoffs for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may lead to missed diagnoses.
Purpose of the Study:
- To evaluate the sensitivity and specificity of standard ESR and CRP cutoffs for PJI screening.
- To determine optimal ESR and CRP thresholds for achieving at least 95% sensitivity in PJI detection.
Main Methods:
- Retrospective analysis of 81 PJI patients and 83 noninfected patients.
- Calculation of sensitivity and specificity for ESR and CRP at standard and optimized cutoffs.
- Determination of optimal cutoffs to achieve ≥95% sensitivity.
Main Results:
- The optimal ESR cutoff for ≥95% sensitivity was 10 mm/h.
- The optimal CRP cutoff for ≥95% sensitivity was 5 mg/L.
- Combined ESR (10 mm/h) and CRP (5 mg/L) achieved 100% sensitivity but 54.7% specificity.
Conclusions:
- Standard ESR (30 mm/h) and CRP (10 mg/L) cutoffs exhibit low sensitivity for PJI screening, resulting in high false-negative rates.
- Lowering ESR to 10 mm/h and CRP to 5 mg/L significantly enhances sensitivity for PJI detection.
- Adjusting these thresholds is vital to prevent the morbidity associated with missed PJI diagnoses.
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