The diagnostic role of albumin-based ratio markers for periprosthetic joint infection

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Published on: December 3, 2017

Panlong Fan1, Qianqian Cao1, Liya Sun2

  • 1Department of Orthopaedics, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.

Frontiers in Cellular and Infection Microbiology
|August 8, 2026
PubMed
Abstract

Insights

New albumin (ALB) ratio biomarkers show promise for diagnosing periprosthetic joint infection (PJI). The CRP/ALB ratio (CAR) and composite index CAR + EAR (CEAR) demonstrated high accuracy, aiding in PJI diagnosis.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Biochemistry

Background:

  • Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty.
  • Accurate PJI diagnosis is critical but challenging, as single biomarkers are often insufficient.
  • Albumin (ALB) ratio-based inflammatory marker combinations are underexplored for PJI diagnosis.

Purpose of the Study:

  • To investigate the diagnostic efficacy of novel biomarkers based on albumin ratios for PJI.
  • To evaluate the performance of CRP/ALB ratio (CAR), ESR/ALB ratio (EAR), and CEAR in differentiating PJI from aseptic loosening (AL).

Main Methods:

  • Retrospective analysis of 257 PJI patients and 137 AL patients.
  • Comparison of serum levels of CRP, ESR, ALB, CAR, EAR, and CEAR.
  • Diagnostic performance assessed using ROC curves and AUC.

Main Results:

  • PJI patients had significantly higher CRP, ESR, CAR, EAR, and CEAR levels, and lower serum ALB compared to AL patients.
  • Novel markers CAR, EAR, and CEAR demonstrated high diagnostic accuracy.
  • CAR (AUC=0.929) and CEAR (AUC=0.917) showed superior performance compared to EAR (AUC=0.890).

Conclusions:

  • Albumin ratio-based markers are promising adjunctive diagnostic tools for PJI.
  • CEAR diagnostic efficacy is comparable to CAR, both outperforming EAR.
  • These novel biomarkers can improve PJI diagnosis accuracy.
Keywords:
aseptic looseningbiomarkersdiagnosisperiprosthetic joint infectionserum albumin

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