Background： Periprosthetic joint infection （PJI） is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of ...Background： Periprosthetic joint infection （PJI） is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein （CRP）, can provide high value in the diagnosis of PJl remains unanswered and, therefore, was the aim of the study. Methods： First, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as ＂periprosthetic joint infection＂, ＂synovial fluid＂, and ＂C-reactive protein＂. Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio （DOR）, summary receiver operating characteristic （SROC） curve, and the area under the SROC （AUSROC） were pooled together and used to evaluate overall diagnostic performance. Results： Seven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 （95% confidence interval [CI]： 0.86-0.96）, 0.90 （95% CI： 0.87-0.93）, and 101.40 （95% CI： 48.07-213.93）, respectively. The AUSROC was 0.9663 （standard error, 0.0113）. Conclusions： Synovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity.展开更多
目的构建基于血清和关节液炎性标志物诊断关节置换术后假体周围感染(prosthetic joint infections,PJI)的列线图诊断模型,并验证其预测能力。方法回顾性收集2015年1月至2020年6月于重庆医科大学附属第一医院骨科诊断为PJI或无菌性松动的...目的构建基于血清和关节液炎性标志物诊断关节置换术后假体周围感染(prosthetic joint infections,PJI)的列线图诊断模型,并验证其预测能力。方法回顾性收集2015年1月至2020年6月于重庆医科大学附属第一医院骨科诊断为PJI或无菌性松动的181例患者临床资料作为建模组。通过lasso回归、单因素及多因素分析筛选出诊断PJI的最佳指标。通过综合考量各项指标的权重及内在联系,构建列线图诊断模型,并以此开发临床决策支持系统(clinical decision support system,CDSS)。前瞻性收集2020年7月至2022年12月于重庆医科大学附属第一医院骨科诊断为PJI或无菌性松动的49例患者作为验证组,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)等方法对列线图模型的诊断性能进行外部验证。结果181例建模组中PJI患者85例,49例验证组中PJI患者23例。在27个潜在因素中通过lasso回归分析发现体质指数(body mass index,BMI)、血液指标[包括血小板、淋巴细胞绝对值、干扰素γ(interferonγ,IFN-γ)、红细胞沉降率、IL-6、C反应蛋白、D-二聚体]及关节液指标(包括C反应蛋白、IL-1、IL-4、IL-6、多核中性粒细胞百分比、CD64)可能是诊断PJI的潜在指标。单因素回归分析发现血液学指标(包括红细胞沉降率、C反应蛋白、IL-6、D-二聚体)和关节液指标(包括C反应蛋白、关节液CD64指数、C反应蛋白、IL-1、IL-4、IL-6、关节液多形核白细胞百分比)的差异有统计学意义(P<0.05)。多因素回归分析筛选出血清IL-6、D-二聚体、关节液CD64指数、C反应蛋白、IL-1、IL-4、IL-6及关节液多形核白细胞百分比等指标,以此为基础构建列线图模型和CDSS系统。验证组外部验证ROC曲线下面积(area under the curve,AUC)为0.978,内部验证AUC为0.995;校准曲线C指数为99.50%,内部验证C指数为99.53%,提示列线图模型在临床应用中具有良好的预测能力。结论�展开更多
文摘Background： Periprosthetic joint infection （PJI） is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein （CRP）, can provide high value in the diagnosis of PJl remains unanswered and, therefore, was the aim of the study. Methods： First, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as ＂periprosthetic joint infection＂, ＂synovial fluid＂, and ＂C-reactive protein＂. Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio （DOR）, summary receiver operating characteristic （SROC） curve, and the area under the SROC （AUSROC） were pooled together and used to evaluate overall diagnostic performance. Results： Seven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 （95% confidence interval [CI]： 0.86-0.96）, 0.90 （95% CI： 0.87-0.93）, and 101.40 （95% CI： 48.07-213.93）, respectively. The AUSROC was 0.9663 （standard error, 0.0113）. Conclusions： Synovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity.
文摘目的构建基于血清和关节液炎性标志物诊断关节置换术后假体周围感染(prosthetic joint infections,PJI)的列线图诊断模型,并验证其预测能力。方法回顾性收集2015年1月至2020年6月于重庆医科大学附属第一医院骨科诊断为PJI或无菌性松动的181例患者临床资料作为建模组。通过lasso回归、单因素及多因素分析筛选出诊断PJI的最佳指标。通过综合考量各项指标的权重及内在联系,构建列线图诊断模型,并以此开发临床决策支持系统(clinical decision support system,CDSS)。前瞻性收集2020年7月至2022年12月于重庆医科大学附属第一医院骨科诊断为PJI或无菌性松动的49例患者作为验证组,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)等方法对列线图模型的诊断性能进行外部验证。结果181例建模组中PJI患者85例,49例验证组中PJI患者23例。在27个潜在因素中通过lasso回归分析发现体质指数(body mass index,BMI)、血液指标[包括血小板、淋巴细胞绝对值、干扰素γ(interferonγ,IFN-γ)、红细胞沉降率、IL-6、C反应蛋白、D-二聚体]及关节液指标(包括C反应蛋白、IL-1、IL-4、IL-6、多核中性粒细胞百分比、CD64)可能是诊断PJI的潜在指标。单因素回归分析发现血液学指标(包括红细胞沉降率、C反应蛋白、IL-6、D-二聚体)和关节液指标(包括C反应蛋白、关节液CD64指数、C反应蛋白、IL-1、IL-4、IL-6、关节液多形核白细胞百分比)的差异有统计学意义(P<0.05)。多因素回归分析筛选出血清IL-6、D-二聚体、关节液CD64指数、C反应蛋白、IL-1、IL-4、IL-6及关节液多形核白细胞百分比等指标,以此为基础构建列线图模型和CDSS系统。验证组外部验证ROC曲线下面积(area under the curve,AUC)为0.978,内部验证AUC为0.995;校准曲线C指数为99.50%,内部验证C指数为99.53%,提示列线图模型在临床应用中具有良好的预测能力。结论�
