Artikel
Diagnostic accuracy of synovial biomarkers in periprosthetic joint infection – A comprehensive meta-analysis
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Autoren
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Sufian S. Ahmad
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Michael T. Hirschmann
- Dept. of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, Basel, Switzerland
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Atesch Ateschrang
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Roland Becker
- Städtisches Klinikum Brandenburg, Zentrum für Orthopädie und Unfallchirurgie, Brandenburg, Germany
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Christoph Albers
- Universität Bern, Inselspital, Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
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Sandro Kohl
- Universität Bern, Inselspital, Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
| Veröffentlicht: | 6. November 2018 |
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Gliederung
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Objectives: It was the purpose (1) to review the literature for articles related to synovial biomarkers of prosthetic joint infection (PJI) and (2) to determine the accuracy and effectiveness of these as diagnostic tools for PJI.
Methods: An EMBASE and MEDLINE (PubMed) databases search was performed using a set of professionally set search terms. Two independent reviewers rated eligible articles. Sensitivity and specificity were meta-analysed using a bivariate random-effects model.
Results: Accuracy values were extracted from 42 articles. Pooled sensitivity and specificity of the represented biomarkers were: alpha-defensin ELISA 0.97 (95% CI: 0.91-0.99) and 0.97 (95% CI: 0.94-0.98), respectively. Synovasure testkit assay 0.80 (95% CI: 0.65-0.89) and 0.89 (95% CI: 0.76-0.96), respectively. Synovial leukocyte esterase 0.79 (95% CI: 0.67-0.87) and 0.92 (95% CI: 0.87-0.92), respectively. Synovial interleukin-6 0.76 (95% CI: 0.65-0.84) and 0.91 (95% CI: 0.88-0.94), respectively. Synovial fluid CRP 0.86 (95% CI: 0.81-0.91), and 0.90 (95% CI: 0.86-0.93), respectively.
Conclusion: The alpha-defensin ELISA test demonstrated the highest ever reported accuracy for PJI diagnosis, however, this does not apply for the Synovasure alpha-defensin testkit. The Synovasure alpha-defensin testkit, synovial CRP, synovial Interleukin-6 and synovial Leukocyte esterase showed an overall similar high diagnostic accuracy, however, not higher than the overall accuracy previously reported for synovial white cell count (sWBC) or culture bacteriology. Therefore, the stage of using a single biomarker as a standalone diagnostic tool for PJI is not yet reached.
