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Published on: December 3, 2017
Limited value of platelet-related markers in diagnosing periprosthetic joint infection
Zhen-Yu Song1, Jin-Cheng Huang2, Dong-Hui Wang1
1Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Objective:
To evaluate the diagnostic values of serum platelet count (PC), mean platelet volume ratio (MPV), platelet count to mean platelet volume ratio (PVR), platelet to lymphocyte ratio (PLR), platelet to neutrophil ratio (PNR), PC/Albumin-globulin ratio (PC/AGR), and PC/C-reactive protein (PC/ CRP) in the diagnosis of periprosthetic joint infection (PJI).
Methods:
The medical records were retrospectively analyzed of the 158 patients who had undergone hip or knee revisions from January 2018 to May 2022. Of them, 79 cases were diagnosed with PJI and 79 with aseptic loosening (AL). PJI was defined using the Musculoskeletal Infection Society criteria. The plasma levels of CRP, the erythrocyte sedimentation rate (ESR), PC, MPV, PVR, PLR, PNR, PC/AGR, and PC/CRP in the 2 groups were recorded and analyzed. In addition, tests were performed according to different joint types. The receiver operating characteristic curve was used to calculate the sensitivity and specificity of each indicator. The diagnostic value for each indicator was calculated according to the area under the curve (AUC).
Results:
The PC, PVR, PLR and PC/AGR levels in the PJI group were significantly higher than those in the AL group, while PC/CRP levels were significantly lower (P < 0.001). The AUC for PC/CRP, and PC/AGR was 0.804 and 0.802, respectively, which were slightly lower than that of CRP (0.826) and ESR (0.846). ROC analysis for PC/CRP, and PC/AGR revealed a cut-off value of 37.80 and 160.63, respectively, which provided a sensitivity of 73.42% and 84.81% and a specificity of 75.95% and 65.82% for PJI. The area under the curve of PLR and PC was 0.738 and 0.702. The area under the curve values for PVR, PNR, and MPV were 0.672, 0.553, and 0.544, respectively.
Conclusions:
The results of this study suggest that PC, PLR, PC/CRP, and PC/AGR values do not offer significant advantages over ESR or CRP values when employed for the diagnosis of PJI. PVR, PNR, and MPV were not reliable in the diagnosis of PJI.
Insights
Serum platelet count (PC) and related ratios show limited diagnostic value for periprosthetic joint infection (PJI). While PC/C-reactive protein (PC/CRP) and PC/Albumin-globulin ratio (PC/AGR) demonstrated moderate accuracy, they were not superior to established markers like CRP or ESR for diagnosing PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Biomarkers
Background:
- Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
- Accurate and timely diagnosis of PJI is crucial for effective treatment and patient outcomes.
- Novel diagnostic markers are continuously being investigated to improve PJI detection.
Purpose of the Study:
- To evaluate the diagnostic utility of serum platelet count (PC) and various platelet-related ratios for PJI.
- To compare the diagnostic performance of PC, MPV, PVR, PLR, PNR, PC/AGR, and PC/CRP against established inflammatory markers (CRP, ESR).
Main Methods:
- Retrospective analysis of 158 patients undergoing hip or knee revision surgery (79 PJI, 79 aseptic loosening).
- Measurement of serum levels for PC, MPV, PVR, PLR, PNR, PC/AGR, PC/CRP, CRP, and ESR.
- Receiver operating characteristic (ROC) curve analysis to determine sensitivity, specificity, and area under the curve (AUC) for each marker.
Main Results:
- Significantly higher PC, PVR, PLR, and PC/AGR levels were observed in the PJI group compared to the aseptic loosening group.
- Significantly lower PC/CRP levels were found in the PJI group.
- AUC values for PC/CRP (0.804) and PC/AGR (0.802) were comparable to CRP (0.826) and ESR (0.846), but PVR, PNR, and MPV showed lower diagnostic accuracy.
Conclusions:
- Serum PC, PLR, PC/CRP, and PC/AGR do not offer significant diagnostic advantages over ESR or CRP for PJI.
- PVR, PNR, and MPV are not reliable indicators for diagnosing PJI.
- Established markers like CRP and ESR remain valuable tools in the diagnosis of PJI.
