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The Albumin to Globulin Ratio Performs Well for Diagnosing Periprosthetic Joint Infection: A Single-Center
Mingjie Dong1, Yushan Wang1, Hao Fan1
1Department of Orthopaedics, The Second Clinical Medical College of Shanxi Medical University, TaiYuan, China.
Background:
Accurate diagnosis of the periprosthetic joint infection (PJI) remains a challenge for surgeons. The purpose of this study was to assess the value of albumin to globulin ratio (AGR) and globulin (GLB) for diagnosing PJI.
Methods:
A total of 182 patients undergoing revision after arthroplasty were included and divided into 2 groups, 61 in knee group (PJI: 38; non-PJI: 23) and 121 in hip group (PJI: 26; non-PJI: 95). We used receiver operating characteristic curves to determine the diagnostic value of AGR, GLB, inflammatory markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]).
Results:
The receiver operating characteristic curves showed the areas under the curve of AGR, GLB, ESR, and CRP in the knee group were 0.940, 0.928, 0.867, and 0.848, respectively, and they were 0.855, 0.831, 0.886, and 0.912 in the hip group. The optimal predictive cut-off values for AGR in knee and hip groups were 1.375 and 1.295, respectively. The sensitivity and specificity of AGR, respectively, were 94.7% and 87.0% (knee group) and 84.6% and 75.8% (hip group) for diagnosing PJI. The sensitivity of "AGR or ESR" and specificity of "AGR and GLB" in the knee group were 99.6% and 98.9%, respectively.
Conclusion:
For knee or hip groups, the AGR exhibits good value for the diagnosis of PJI comparable with ESR and CRP. The AGR and GLB, together with CRP and ESR, should be used as the preferred indicators for diagnosing PJI. The "AGR or ESR" and "AGR and GLB" in the knee group have an excellent diagnostic value in sensitivity and specificity, respectively.
Insights
The albumin to globulin ratio (AGR) shows promise for diagnosing periprosthetic joint infection (PJI), comparable to established markers like ESR and CRP. Combining AGR with other markers like globulin (GLB) and C-reactive protein (CRP) enhances diagnostic accuracy for PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Biomarkers
Background:
- Accurate diagnosis of periprosthetic joint infection (PJI) is a significant clinical challenge.
- Existing diagnostic methods for PJI require improvement in accuracy and efficiency.
Purpose of the Study:
- To evaluate the diagnostic utility of the albumin to globulin ratio (AGR) and globulin (GLB) for periprosthetic joint infection (PJI).
- To compare the diagnostic performance of AGR and GLB with established inflammatory markers.
Main Methods:
- A cohort of 182 patients undergoing revision arthroplasty was analyzed.
- Receiver operating characteristic (ROC) curves were employed to assess the diagnostic value of AGR, GLB, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
Main Results:
- AGR demonstrated high diagnostic accuracy in both knee (AUC: 0.940) and hip (AUC: 0.855) PJI cases.
- Optimal cut-off values for AGR were identified as 1.375 for knee and 1.295 for hip PJI.
- Combined markers, such as "AGR or ESR" and "AGR and GLB", showed excellent sensitivity (99.6%) and specificity (98.9%) in the knee group.
Conclusions:
- The albumin to globulin ratio (AGR) is a valuable biomarker for diagnosing PJI, performing comparably to ESR and CRP.
- AGR and GLB, alongside CRP and ESR, are recommended as preferred indicators for PJI diagnosis.
- Specific combinations of these markers offer superior diagnostic performance, particularly in knee PJI cases.
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