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Laboratory-Reported Normal Value Ranges Should Not Be Used to Diagnose Periprosthetic Joint Infection.

Salvador A Forte1, Joseph A D'Alonzo1, Zachary Wells1

  • 1Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.

Cureus
|August 30, 2022
PubMed
Summary
This summary is machine-generated.

Laboratory reporting of multipurpose tests like ESR and CRP varies, potentially leading to misdiagnosis of periprosthetic joint infection (PJI). Standardized thresholds are crucial for accurate PJI diagnosis.

Keywords:
diagnosisinfectionlaboratorypjithatka

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Area of Science:

  • Clinical diagnostics
  • Orthopedic surgery
  • Infectious disease

Background:

  • Multipurpose laboratory tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are widely used but lack standardized interpretation thresholds.
  • The 2018 International Consensus Meeting on Musculoskeletal Infection (ICM) established optimized thresholds for diagnosing periprosthetic joint infection (PJI).
  • Discrepancies between standard laboratory thresholds and PJI-optimized thresholds have not been previously investigated.

Purpose of the Study:

  • To assess the variability in normal thresholds for common PJI diagnostic tests across clinical laboratories.
  • To evaluate the diagnostic impact of using standard laboratory thresholds versus PJI-optimized thresholds.

Main Methods:

  • A survey of 85 clinical laboratories identified units of measure and normal thresholds for ESR, CRP, D-dimer, synovial fluid white blood cells (SF-WBC), and polymorphonuclear cell percentage (SF-PMN%).
  • Variability in units and thresholds was analyzed.
  • A patient dataset was used to compare diagnostic interpretations using laboratory-reported versus ICM-recommended thresholds.

Main Results:

  • Significant variation in units of measure and normal thresholds was observed for CRP and D-dimer.
  • Laboratory-reported normal thresholds were consistently lower than 2018 ICM-recommended PJI-optimized thresholds.
  • Using laboratory-reported thresholds resulted in higher false-positive rates for PJI diagnosis across all tested multipurpose laboratory tests.

Conclusions:

  • Clinical laboratories use non-standardized units and thresholds for multipurpose tests, which often do not align with 2018 ICM recommendations for PJI diagnosis.
  • Lower-than-recommended laboratory thresholds can lead to misinterpretation and false-positive results for PJI.
  • Adherence to 2018 ICM-recommended units and thresholds is essential for accurate PJI diagnosis.