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Published on: December 3, 2017
Synovial Fluid d-Lactate-A Novel Pathogen-Specific Biomarker for the Diagnosis of Periprosthetic Joint Infection
Svetlana Karbysheva1, Katsiaryna Yermak2, Ludmila Grigoricheva3
1Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Federal Center of Traumatology, Orthopedics and Arthroplasty, Barnaul, Russia; Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.
Background:
Synovial fluid d-lactate may be useful for diagnosing periprosthetic joint infection (PJI) as this biomarker is exclusively produced by bacteria. We evaluated the performance of synovial fluid d-lactate using 2 definition criteria and determined its optimal cutoff value for diagnosing PJI.
Methods:
Consecutive patients undergoing joint aspiration before prosthesis revision were prospectively included. Synovial fluid was collected for culture, leukocyte count, and d-lactate concentration (by spectrophotometry). Youden's J statistic was used for determining optimal d-lactate cutoff value on the receiver operating characteristic curve by maximizing sensitivity and specificity.
Results:
A total of 224 patients were included. Using Musculoskeletal Infection Society criteria, 71 patients (32%) were diagnosed with PJI and 153 (68%) with aseptic failure (AF), whereas using institutional criteria, 92 patients (41%) were diagnosed with PJI and 132 (59%) with AF. The optimal cutoff of synovial fluid d-lactate to differentiate PJI from AF was 1.3 mmol/L, independent of the used definition criteria. Synovial fluid d-lactate had a sensitivity of 94.3% (95% confidence interval [95% CI], 86.2-98.4) and specificity of 78.4% (95% CI, 66.8-81.2) using Musculoskeletal Infection Society criteria, whereas its sensitivity was 92.4% (95% CI, 84.9-96.9) and specificity 88.6% (95% CI, 81.9-93.5) using institutional criteria. The concentration of d-lactate was higher in infections caused by Staphylococcus aureus (P < .001) and streptococci (P = .016) than by coagulase-negative staphylococci or in culture-negative PJI.
Conclusion:
The synovial fluid d-lactate showed high sensitivity (>90%) for diagnosis of PJI using both definition criteria and correlated with the pathogen virulence. The high sensitivity makes this biomarker useful as a point-of-care screening test for PJI.
Level Of Evidence:
Diagnostic level I.
Insights
Synovial fluid d-lactate is a sensitive biomarker for diagnosing periprosthetic joint infection (PJI), showing over 90% sensitivity. This finding supports its use as a rapid point-of-care screening test for PJI.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biochemistry
Background:
- Periprosthetic joint infection (PJI) diagnosis can be challenging.
- Synovial fluid d-lactate is a bacterial byproduct, making it a specific marker for infection.
Purpose of the Study:
- To evaluate the diagnostic performance of synovial fluid d-lactate for PJI.
- To determine the optimal cutoff value for d-lactate in diagnosing PJI.
Main Methods:
- Prospective inclusion of patients undergoing joint aspiration.
- Measurement of synovial fluid d-lactate concentration via spectrophotometry.
- Utilized Youden's J statistic and ROC curves to find the optimal cutoff value.
Main Results:
- A total of 224 patients were analyzed.
- The optimal d-lactate cutoff was 1.3 mmol/L, irrespective of diagnostic criteria used.
- Achieved high sensitivity (>90%) for PJI diagnosis with both Musculoskeletal Infection Society and institutional criteria.
Conclusions:
- Synovial fluid d-lactate demonstrates high sensitivity for PJI diagnosis.
- The biomarker's concentration correlates with pathogen virulence.
- It is a valuable tool for point-of-care screening of PJI.
