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Published on: February 2, 2024
Neutrophil to Lymphocyte Ratio and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis
Maryam Salimi1, Joseph Albert Karam2, Matthew Willman3
1Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Background:
The neutrophil-to-lymphocyte ratio (NLR) has shown promising results as a diagnostic tool for periprosthetic joint infection (PJI) after total joint arthroplasty. We conducted a systematic review and meta-analysis to determine the utility of NLR in the diagnosis of PJI.
Methods:
We searched PubMed, Scopus, and Web of Science from inception up to 2022 and evaluated the quality of the included literature.
Results:
Based on the 12 eligible studies, NLR levels were significantly higher in patients who had PJI compared to those who had aseptic loosening (standard mean difference (SMD) = 1.05, 95% Confidence Interval (CI) = 0.71 to 1.40, P < .001). In the subgroup analysis according to type of PJI, NLR levels were significantly higher in patients who had either acute (SMD = 1.04, 95% CI = 0.05 to 2.03, P < .001) or chronic PJI (SMD = 1.08, 95% CI = 0.55 to 1.61, P < .001), compared to those who had aseptic loosening. According to type of arthroplasty, NLR levels were significantly higher in patients who had either total knee arthroplasty (SMD = 1.81, 95% CI = 1.48 to 2.13, P < .001) or total hip arthroplasty (SMD = 1.76, 95% CI = 1.54 to 1.98, P < .001) compared to aseptic loosening. The pooled sensitivity of the 12 studies was 0.73 (95% CI, 0.65 to 0.79), and the pooled specificity was 0.75 (95% CI, 0.71 to 0.78). The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of NLR were 2.94 (95% CI = 2.44 to 3.54), 0.35 (95% CI = 0.27 to 0.46), and 8.26 (95% CI = 5.42 to 12.58), respectively.
Conclusion:
In summary, this meta-analysis indicates that NLR is a reliable marker in the diagnosis of PJI.
Insights
The neutrophil-to-lymphocyte ratio (NLR) is a reliable marker for diagnosing periprosthetic joint infection (PJI) after joint replacement surgery. This meta-analysis confirms its diagnostic utility in various PJI types and arthroplasty procedures.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Biomarkers
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty.
- The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker for PJI diagnosis.
- This study systematically reviews and meta-analyzes the utility of NLR in diagnosing PJI.
Approach:
- A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science up to 2022.
- Included studies were rigorously evaluated for quality.
- A meta-analysis was performed to synthesize the diagnostic performance of NLR for PJI.
Key Points:
- NLR levels were significantly elevated in patients with PJI compared to aseptic loosening.
- Subgroup analyses confirmed higher NLR in acute and chronic PJI, and in total knee and hip arthroplasty cases.
- The pooled sensitivity and specificity for NLR in PJI diagnosis were 0.73 and 0.75, respectively.
Conclusions:
- The neutrophil-to-lymphocyte ratio (NLR) demonstrates significant diagnostic value for periprosthetic joint infection (PJI).
- NLR serves as a reliable and accessible biomarker for identifying PJI across different clinical scenarios.
- This meta-analysis supports the integration of NLR into diagnostic algorithms for PJI.
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