scholarly journals Limited value of serum neutrophil-to-lymphocyte ratio in the diagnosis of chronic periprosthetic joint infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yongyu Ye ◽  
Weishen Chen ◽  
Minghui Gu ◽  
Qiaoli Liu ◽  
Guoyan Xian ◽  
...  
Keyword(s):  
Roc Curve ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Univariate Analysis ◽  
Revision Arthroplasty ◽  
Diagnostic Value ◽  
Neutrophil To Lymphocyte Ratio ◽  
Optimal Threshold ◽  
Level Of Evidence ◽  
Lymphocyte Ratio

Abstract Background Diagnosing chronic periprosthetic joint infection (PJI) is challenging. No single biomarker can accurately recognize PJI preoperatively in a timely manner. Therefore, the aim of the present study was to investigate the usefulness of the serum neutrophil-to-lymphocyte ratio (NLR) in aiding the diagnosis of chronic PJI. Materials and methods We retrospectively evaluated the medical records of 158 patients who had undergone revision arthroplasty (104 with aseptic mechanic failure and 54 with chronic PJI) from July 2011 to July 2020. Univariate analysis followed by multivariate logistic regression was applied to compare NLR, C-reactive protein (CRP), and erythrocyte sedimentation ratio (ESR) between the two groups. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of NLR alone and in combination with CRP and ESR. Results NLR, CRP, and ESR were significantly higher in patients with chronic PJI than in the aseptic revision group (p < 0.05). ROC curve analysis revealed that NLR had a sensitivity of 57.41% and a specificity of 77.88% with an optimal threshold of 2.56. The optimal threshold for CRP and ESR was 7.00 mg/L (sensitivity 62.50% and specificity 83.12%) and 43 mm/h (sensitivity 59.38% and specificity 80.52%), respectively. The combined diagnostic value of NLR with CRP and ESR was shown to have no additional diagnostic value in predicting chronic PJI. Conclusion Compared with traditional inflammatory biomarkers (ESR and CRP), the value of serum NLR alone or combined with CRP and ESR for diagnosing chronic PJI is limited. Level of evidence Level 3.

scholarly journals Neutrophil-Lymphocyte Ratio as A Complementary Biomarker of Periprosthetic Joint Infection: A Retrospective Review

2020 ◽  
Author(s):  
Yongyu Ye ◽  
Minghui Gu ◽  
Weishen Chen ◽  
Guoyan Xian ◽  
Linli Zheng ◽  
...  
Keyword(s):  
Roc Curve ◽  
Periprosthetic Joint Infection ◽  
Diagnostic Performance ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Diagnostic Odds Ratio ◽  
Bivariate Analysis ◽  
Roc Curve Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Abstract Background: Diagnosing a periprosthetic joint infection (PJI) is challenging. No single biomarker can accurately recognize PJI preoperatively in a timely manner. Therefore, the aim of the present study was to investigate the usefulness of the neutrophil-lymphocyte ratio (NLR) in aiding the diagnosis of PJI.Methods: We retrospectively evaluated the medical records of 109 patients who had undergone revision arthroplasty (77 with aseptic mechanic failure and 32 with PJI) from July 2011 to November 2018. Bivariate analysis followed by multivariate logistic regression was applied to compare NLR between two groups. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of NLR alone and in combination with C-reactive protein (CRP) and the erythrocyte sedimentation ratio (ESR).Results: NLR was significantly higher in patients with PJI than in patients of the aseptic revision group (3.12 ± 2.45 vs. 2.10 ± 1.03, p < 0.05). ROC curve analysis revealed that NLR had a sensitivity of 56.25% and a specificity of 80.52% with an optimal threshold of 2.52. The diagnostic performance of NLR alone was inferior to that of CRP and ESR as demonstrated by the area under curve, sensitivity, and diagnostic odds ratio. When used in combination with CRP, the diagnostic performance was nearly equal to the combined performance of CRP and ESR or that of all three biomarkers (p > 0.05).Conclusions: NLR is associated with PJI and could be regarded as a complementary marker, which in combination with CRP could improve the diagnostic performance for PJI.

scholarly journals Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) Are Potentially Valuable Tests for Diagnosing Periprosthetic Joint Infection

2021 ◽  
Author(s):  
Hao Wu ◽  
Liping Pan ◽  
Zhichao Meng ◽  
Heng Liu ◽  
Xin Yang ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Roc Analysis ◽  
Joint Infection ◽  
Volume Ratio ◽  
Diagnostic Value ◽  
Neutrophil To Lymphocyte Ratio ◽  
Clinical Practices ◽  
Platelet To Lymphocyte Ratio ◽  
Failure Group ◽  
Lymphocyte Ratio

Abstract Background Diagnosis of periprosthetic joint infection (PJI) is challenging for clinicians, and the most commonly used methods are too complicated and expensive for many clinical practices. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet–to-mean platelet volume ratio (PVR), are simple biomarkers of infection and can be easily determined from routine blood tests. The aim of our study is to determine the value of these three parameters for the diagnosis of PJI. Methods One hundred and sixty-four patients who received revision surgery after total knee or total hip replacements were enrolled, 47 in a PJI group and 117 in an aseptic failure group. Receiver operator characteristic (ROC) analysis was used to compare the performance of NLR, PLR, PVR, C reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of PJI. Results The levels of NLR, PLR, and PVR were significantly higher in patients with PJI (all P < 0.05). ROC analysis showed that the area under curve (AUC) values of NLR (0.740), PLR (0.721), and PVR (0.668) were lower than those for CRP (0.896) and ESR (0.829). PLR had the highest sensitivity (85.11%) among all tested biomarkers, and NLR improved the diagnostic performance when used with CRP. Conclusion NLR and PLR are potentially valuable tests for the diagnosis of PJI, but PVR only has limited diagnostic value.

scholarly journals Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bao-Zhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-Bo Hao ◽  
Ji-Ying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Early Postoperative Period ◽  
Infected Group ◽  
Neutrophil To Lymphocyte Ratio ◽  
Musculoskeletal Infection ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. Methods We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. Results The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6 mg/l in the uninfected group (p < 0.001). The median of ESR was 34.8 mm/hr. in the infected group and 17.4 mm/hr. in the uninfected group (p < 0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p < 0.001). The median of IL-6 was 46 pg/ml and 6.4 pg/ml (p < 0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632). Conclusions This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

scholarly journals Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

2020 ◽  
Author(s):  
BaoZhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
LiBo Hao ◽  
Jiying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Early Postoperative Period ◽  
Infected Group ◽  
Neutrophil To Lymphocyte Ratio ◽  
Musculoskeletal Infection ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty.Methods: We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter.The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated.Results: The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/hr in the uninfected group (p<0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p<0.001). The median of IL-6 was 46pg/ml and 6.4pg/ml (p<0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC=0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632).Conclusions: This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

scholarly journals Serum Globulin and Albumin to Globulin Ratio as Potential Diagnostic Biomarkers for Periprosthetic Joint Infection: A Retrospective Review

2020 ◽  
Author(s):  
Yongyu Ye ◽  
Weishen Chen ◽  
Minghui Gu ◽  
Guoyan Xian ◽  
Baiqi Pan ◽  
...  
Keyword(s):  
Roc Curve ◽  
Periprosthetic Joint Infection ◽  
Diagnostic Performance ◽  
Serum Proteins ◽  
Joint Infection ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Roc Curve Analysis ◽  
Serum Globulin ◽  
G Ratio

Abstract Background: Periprosthetic joint infection (PJI) has been increasingly documented; however, its preoperative accurate diagnosis remains challenging. Furthermore, there is a dire need to identify appropriate and effective biomarkers. We aimed to evaluate the relationship between globulin, albumin to globulin (A/G) ratio, and development of PJI in patients undergoing revision total joint arthroplasty (TJA).Methods: A retrospective study was conducted on patients who had undergone revision TJA between 2011 and 2018 (89 with aseptic mechanic failure and 38 with PJI). The serum proteins were explored using univariate analysis followed by multivariate logistic regression. The diagnostic performance of these proteins was assessed by the receiver operating characteristic (ROC) curve.Results: Higher globulin levels (odds ratio [OR], 1.239; P<0.001) and lower A/G ratio (OR, 0.007; P<0.001) were strongly associated with the risk of PJI. ROC curve analysis demonstrated reasonable diagnostic performance for globulin (area under the curve [AUC], 0.77; sensitivity, 78.95%; and specificity, 69.66%) and A/G ratio (AUC, 0.779; sensitivity, 65.79%; and specificity, 78.65%).Conclusions: Both globulin and A/G ratio were associated with PJI and may serve as potential adjuvant biomarkers in the diagnosis of PJI.

scholarly journals Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

2020 ◽  
Author(s):  
BaoZhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
LiBo Hao ◽  
Jiying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Neutrophil To Lymphocyte Ratio ◽  
Optimal Cutoff ◽  
Musculoskeletal Infection ◽  
Cutoff Value ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. Methods We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018. There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR, interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. Results The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The mean CRP (infected = 59.06, uninfected = 10.09), ESR (infected = 35, uninfected = 17), WBC(infected = 7.95 × 109,uninfected = 6.16 × 109), NLR (infected = 4.89, uninfected = 2.18), IL-6 (infected = 40.68, uninfected = 7.46).. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 81.4%; optimal cutoff value 8.07 pg/ml) followed by the NLR (AUC = 80.2%; optimal cutoff value 2.13), CRP (AUC = 79.3%; optimal cutoff value 9.27 mg/l), ESR (AUC = 74.4%; optimal cutoff value 22 mm/h) and WBC (AUC = 63.2%; optimal cutoff value 8.91 × 109). Conclusions This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

Predictive value of postoperative neutrophil-to-lymphocyte ratio on the early Periprosthetic joint infection after total joint arthroplasty: a pilot study

2020 ◽  
Author(s):  
Guang lei Zhao ◽  
Jie Chen ◽  
Jin Wang ◽  
Siqun Wang ◽  
Jun Xia ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
Predictive Value ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Neutrophil To Lymphocyte Ratio ◽  
Receiver Operating Curve ◽  
Lymphocyte Ratio ◽  
Normal White Blood Cell ◽  
High Level

Abstract Objective : The purpose of this study was to evaluate the predictive value of the postoperative neutrophil-to-lymphocyte ratio on early periprosthetic joint infection. Methods : During the period from January 2008 to December 2016, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty in the department of orthopedics in our Hospital were enrolled in our study. All of the relevant clinical information and laboratory indexes were reviewed from the our Hospital Follow-up system. The time when any abnormal symptoms or signs occurred including fever, local swelling or redness around the surgical site 2 weeks after the operations was defined as the “suspect time”. We compared the laboratory parameters including the NLR 、PLR、LMR、ESR and the CRP between the two groups. The trend of the NLR、LMR、PLR、CRP and ESR were also reviewed after the surgery. The predictive ability of these parameters at suspect time on the early PJI were evaluated by multivariate analysis and the Receiver operating curve analysis (ROC). Results : NLR, PLR and LMR returned to preoperative level within two weeks in two groups after surgery. In the early PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cell. Interesting, the ESR and CRP were still in relative high level two weeks after the operation and the change of these two indexes was not obvious when the infection occurs. The NLR and PLR was significantly correlated with the early PJI (OR NLR =88.36, OR PLR =1.12, P NLR =0.005, P PLR =0.01) and the NLR has a great predict ability for early PJI with the cut-off value 2.77 (Sensitivity=84.6% ，Specificity=89.7%, 95% CI=0.86-0.97) Conclusions: ESR and CRP are not sensitive for diagnosis of early PJI due to their persistent high level after arthroplasty. The postoperative NLR at suspect time have a great ability in predicting early PJI and more attention should be applied to it.

scholarly journals Serum globulin and albumin to globulin ratio as potential diagnostic biomarkers for periprosthetic joint infection: a retrospective review

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yongyu Ye ◽  
Weishen Chen ◽  
Minghui Gu ◽  
Guoyan Xian ◽  
Baiqi Pan ◽  
...  
Keyword(s):  
Roc Curve ◽  
Periprosthetic Joint Infection ◽  
Diagnostic Performance ◽  
Serum Proteins ◽  
Joint Infection ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Roc Curve Analysis ◽  
Serum Globulin ◽  
G Ratio

Abstract Background Periprosthetic joint infection (PJI) has been increasingly documented; however, its preoperative accurate diagnosis remains challenging. Furthermore, there is a dire need to identify appropriate and effective biomarkers. We aimed to evaluate the relationship between globulin, albumin to globulin (A/G) ratio, and development of PJI in patients undergoing revision total joint arthroplasty (TJA). Methods A retrospective study was conducted on patients who had undergone revision TJA between 2011 and 2018 (89 with aseptic mechanic failure and 38 with PJI). The serum proteins were explored using univariate analysis followed by multivariate logistic regression. The diagnostic performance of these proteins was assessed by the receiver operating characteristic (ROC) curve. Results Higher globulin levels (odds ratio [OR], 1.239; P < 0.001) and lower A/G ratio (OR, 0.007; P < 0.001) were strongly associated with the risk of PJI. ROC curve analysis demonstrated reasonable diagnostic performance for globulin (area under the curve [AUC], 0.77; sensitivity, 78.95%; and specificity, 69.66%) and A/G ratio (AUC, 0.779; sensitivity, 65.79%; and specificity, 78.65%). Conclusions Both globulin and A/G ratio were associated with PJI and may serve as potential adjuvant biomarkers in the diagnosis of PJI.

scholarly journals Thromboelastography parameters in diagnosing periprosthetic joint infection and predicting reimplantation timing

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tao Yuan ◽  
Yi Wang ◽  
Shui Sun
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Maximum Amplitude ◽  
Diagnostic Value ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Group A ◽  
Group B ◽  
Α Angle

Abstract Background Coagulation-related biomarkers are drawing new attention in the diagnosis of periprosthetic joint infection (PJI). The thromboelastography (TEG) assay provides a comprehensive assessment of blood coagulation; therefore, it could be a promising test for PJI. This study aims to assess the value of TEG in diagnosing PJI and to determine the clinical significance of TEG in analysing reimplantation timing for second-stage revision. Methods From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included. PJI was defined by the 2011 Musculoskeletal Infection Society criteria, in which 23 patients were diagnosed with PJI (Group A), and the remaining 39 patients were included as having aseptic loosening (Group B). In group A, 17 patients completed a two-stage revision in our centre. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, and TEG parameters (clotting time, α-angle, MA [maximum amplitude], amplitude at 30 min, and thrombodynamic potential index) were measured preoperatively in all included patients. In addition, receiver operating characteristic curves were used to evaluate the diagnostic value of these biomarkers. Results ESR (area under curve [AUC], 0.953; sensitivity, 81.82; specificity, 94.87) performed best for PJI diagnosis, followed by MA (AUC, 0.895; sensitivity, 82.61; specificity, 97.44) and CRP (AUC, 0.893; sensitivity, 82.61; specificity, 94.74). When these biomarkers were combined in pairs, the diagnostic value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. Furthermore, ESR and MA were valuable in determining the time of reimplantation, and their values all decreased below the cut-off values before reimplantation. Conclusion TEG could be a promising test in assisting PJI diagnosis, and a useful tool in judging the proper timing of reimplantation.

scholarly journals Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

2020 ◽  
Author(s):  
BaoZhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
LiBo Hao ◽  
Jiying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Early Postoperative Period ◽  
Infected Group ◽  
Neutrophil To Lymphocyte Ratio ◽  
Musculoskeletal Infection ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty.Methods: We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter.The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated.Results: The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/hr in the uninfected group (p<0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p<0.001). The median of IL-6 was 46pg/ml and 6.4pg/ml (p<0.001),respectively.The best parameter for the diagnosis of early PJI was IL-6 (AUC=0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632).Conclusions: This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

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