Blood Cell Ratio Combinations for Diagnosing Periprosthetic Joint Infections: A Preliminary Study

Area of Science:

• Orthopedics
• Infectious Diseases
• Biomarkers

Background:

• Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA).
• Accurate diagnosis of PJI is crucial for effective management.
• Optimal combinations of inflammatory biomarkers for PJI diagnosis are not well-established.

Purpose of the Study:

• To evaluate the diagnostic performance of various preoperative inflammatory biomarkers for PJI.
• To identify the most effective biomarker combination for improving PJI diagnostic accuracy.

Main Methods:

• A prospective, multi-center study involving 269 patients undergoing revision arthroplasty.
• Patients were classified into PJI (n=93) and aseptic failure (AF) (n=176) groups using 2018 ICM PJI criteria.
• Analysis of biomarkers including CRP, ESR, NLR, CAR, CALLR, PLR, PAR, and NAR, with evaluation by ROC analysis and Youden index.

Main Results:

• Platelet-to-albumin ratio (PAR) and CRP-to-albumin ratio (CAR) were significantly higher in the PJI group (P < 0.05).
• PAR (AUC=0.779) and CAR (AUC=0.718) demonstrated high diagnostic values.
• Combining PAR with CRP and ESR improved sensitivity to 93.8% and specificity to 92.5%.

Conclusions:

• PAR and CAR are effective combined inflammatory biomarkers for PJI diagnosis.
• Other analyzed markers showed limited diagnostic utility for PJI.
• Further research may explore optimal biomarker combinations for PJI.