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Diagnostic accuracy of calprotectin in periprosthetic joint infection: a diagnostic meta-analysis
Jisi Xing1, Jiahao Li2, Zijian Yan2
1Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong Province, China.
Background:
Periprosthetic joint infection (PJI) is considered to be one of the most challenging complications of joint replacement, which remains unpredictable. As a simple and emerging biomarker, calprotectin (CLP) has been considered to be useful in ruling out PJI in recent years. The purpose of this study was to investigate the accuracy and sensitivity of CLP in the diagnosis of PJI.
Methods:
We searched and screened the publications from PubMed, Web of Science, EMBASE, and Cochrane Library from database establishment to June 2021. Subsequently, Stata version 16.0 software was used to combine the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), operating characteristic curve, and area under the curve (AUC). Heterogeneity across articles was evaluated by the I2 statistics. Finally, sources of heterogeneity were detected by subgroup analysis based on study design, detection method, sample size, and cutoff values.
Results:
A total of 7 studies were included in our study, comprising 525 patients. The pooled sensitivity, specificity, PLR, and NLR of CLP for PJI diagnosis were 0.94(95% CI 0.87-0.98), 0.93(95% CI 0.87-0.96), 13.65(95% CI 6.89-27.08), and 0.06(95% CI 0.02-0.15), respectively, while the DOR and AUC were 222.33(95% CI 52.52-941.11) and 0.98 (95% CI 0.96-0.99), respectively.
Conclusion:
Synovial CLP is a reliable biomarker and can be used as a diagnostic criterion for PJI in the future. However, the uncertainty resulting from the poor study numbers and sample sizes limit our ability to definitely draw conclusions on the basis of our study.
Insights
Calprotectin (CLP) shows high accuracy and sensitivity in diagnosing periprosthetic joint infection (PJI). This emerging biomarker shows promise for future diagnostic criteria in joint replacement complications.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biomarker Research
Background:
- Periprosthetic joint infection (PJI) is a significant and unpredictable complication following joint replacement surgery.
- Accurate diagnosis of PJI is crucial for effective patient management and treatment outcomes.
Purpose of the Study:
- To evaluate the diagnostic accuracy and sensitivity of calprotectin (CLP) as a biomarker for PJI.
- To synthesize existing evidence on CLP's utility in differentiating PJI from other conditions.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Web of Science, EMBASE, Cochrane Library) up to June 2021.
- Meta-analysis was performed using Stata v16.0 to pool sensitivity, specificity, likelihood ratios, and diagnostic odds ratio.
- Heterogeneity was assessed using I-squared statistics and explored through subgroup analyses.
Main Results:
- The meta-analysis included 7 studies with 525 patients.
- Pooled sensitivity for CLP in PJI diagnosis was 0.94, and pooled specificity was 0.93.
- The area under the curve (AUC) was high at 0.98, indicating excellent diagnostic performance.
Conclusions:
- Synovial calprotectin (CLP) demonstrates potential as a reliable biomarker for diagnosing PJI.
- CLP may serve as a future diagnostic criterion for PJI, aiding in clinical decision-making.
- Further research with larger sample sizes is recommended to solidify these findings.
