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Six diagnostic tools showed equal utility for PJI in meta-analysis
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SAN DIEGO — C-reactive protein as well as five other key synovial markers for infection — leukocyte esterase, interleukin-6, interleukin-1ß, interleukin-17 and alpha-defensin — perform equally well in the diagnosis of periprosthetic joint infections, based on a systematic review of 23 published articles about synovial markers.
“The focus has shifted recently to synovial markers for diagnosing periprosthetic joint infection (PJI) and clinicians now wonder what the best test for this purpose is,” Anas Saleh, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting.
Researchers at the Cleveland Clinic conducted a study to determine which tests were best to use on a synovial sample. They searched at least three databases through October 2015 for revision total hip and revision total knee arthroplasty studies and used the QUADAS-2 tool to assess the quality of the diagnostic studies they included.
Saleh and colleagues used the area under the curve and the diagnostic odds ratio as surrogates for diagnostic accuracy when they more closely looked at C-reactive protein, leukocyte esterase, interleukin-6, interleukin-1ß, interleukin-17 (IL-17) and alpha-defensin in the studies.
“These are all good markers. There is no difference,” Saleh said.
“For what it is worth, IL-17 had the highest area under the curve,” he said.
Alpha-defensin had the highest diagnostic odds ratio, Saleh said.
“I guess the answer to the research question is, there is no one superior test,” he said.
More research is needed in this area, according to Saleh, and he said his group’s meta-analysis should be updated because more studies that involve leukocyte esterase and alpha-defensin tests have since been published. – by Susan M. Rapp
Reference:
Barsoum WK, et al. Paper #666. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 14-18, 2017; San Diego.
Disclosure: Saleh reports no relevant financial disclosures.