[Preoperative diagnostic efficacy of novel blood markers white blood cell ratio and fibrinogen levels in periprosthetic joint infection].

Abstract

Objective: To investigate the clinical utility of novel of new hematological markers in the preoperative diagnosis of periprosthetic joint infection (PJI).

Methods: A retrospective analysis was conducted on a total of 149 patients who underwent revision of total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single center between January 2016 and June 2022, including 63 males and 86 females, aged from 47 to 93 years old with an average of (69.5±11.8) years old. Of them, 46 were diagnosed as PJI(PJI group), including 22 males and 24 females. The mean age was (71.3±12.5) years old. The body mass index (BMI) was (26.4±3.1) kg·m^-2. And 103 patients were diagnosed as aseptic prosthesis loosening (aseptic group), including 41 males and 62 females. The mean age was (68.7±11.4) years old. The BMI was (25.8±3.5) kg·m^-2. Preoperatively analyzed clinical parameters included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, globulin, albumin-to-globulin ratio (AGR), plasma D-dimer, and plasma fibrinogen. The receiver operating characteristic curve (ROC), sensitivity, and specificity analysis were employed to compare the diagnostic value of each blood marker in preoperative PJI diagnosis.

Results: In the PJI group, the levels of CRP were 16.6 (7.6, 4.5) mg·L^-1, ESR was 17.0 (12.8, 35.5) mm·h^-1, plasma D-dimer was 1.0 (0.5, 3.1) μg·L^-1, and plasma fibrinogen was 4.2 (3.2, 3.1) mg·L^-1;all of which were higher compared to the aseptic group with CRP at 4.2 (2.6, 7.8) mg·L^-1, ESR at 12.0(8.0, 20.0 )mm·h^-l, D-dimer at 0.4(0.2, 0.7)μg·L^-1, and fibrinogen at 2.8(2.4, 3.3 ) g·L^-1(P<0.05). However, the albumin level of 35.3 (32.3, 37.5) g·L^-1 and the WBC ratio of 1.0(0.9, 1.1) in the PJI group were significantly lower compared to the aseptic group with levels of 39.8 (36.1, 41.8) g·L^-1 and 1.4 (1.3, 1.5), respectively (P<0.05). Only the area under the curve (AUC) of AGR and plasma fibrinogen were greater than 0.8. The optimal predictive cut-1off, AUC, sensitivity and specificity were 3.4 g·L-1, 0.820, 69.57% and 84.47% for plasma fibrinogen; 1.18, 0.813, 82.61% and 78.64% for AGR, respectively.

Conclusion: AGR and plasma fibrinogen are promising blood markers for improving the diagnosis of PJI.