scholarly journals Combined serum and synovial C-reactive protein tests: a valuable adjunct to the diagnosis of chronic prosthetic joint infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hai Wang ◽  
Leilei Qin ◽  
Jiawei Wang ◽  
Ning Hu ◽  
Wei Huang
Keyword(s):  
Predictive Value ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Combined Model ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Valuable Adjunct ◽  
Serum Crp

Abstract Background Diagnosis of periprosthetic joint infection (PJI), especially chronic PJI, is very confusing and challenging. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our aim was to investigate the diagnostic value of synovial CRP in chronic PJI and to explore the role of combined serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties. Methods We prospectively enrolled patients scheduled to have a revision surgery for chronic PJI or aseptic loosening from January 2019 to December 2020, in which synovial CRP was additionally measured along with routine preoperative diagnostic serum ((ESR, CRP) and synovial (PMN%) biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy. Results There were no statistically significant differences between the infection (n = 39) and aseptic (n = 58) groups, including 61 hips and 36 knees. The synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 9.93 mg/l vs 3.58 mg/l; p < .001). The optimal cut-off value for detecting chronic PJI of Synovial fluid (SF) CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.26 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1. Conclusions The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI.

scholarly journals Combined Serum and Synovial C-Reactive Protein Tests: An Economical and Efficient Adjunct to the Diagnosis of Chronic Prosthetic Joint Infection

2021 ◽  
Author(s):  
Hai Wang ◽  
Leilei Qin ◽  
Jiawei Wang ◽  
Ning Hu ◽  
Wei Huang
Keyword(s):  
Predictive Value ◽  
Demographic Data ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Combined Model ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Serum Crp

Abstract Background Diagnosis of Periprosthetic joint infection (PJI) is very complex and challenging, especially for chronic PJI. The value of C-reactive protein (CRP) in infectious diseases has been recognized, but the diagnostic value of CRP in chronic PJI is unknown. Our objective was to investigate the effectiveness of synovial CRP in chronic PJI and to determine the optimal combination of serum and synovial CRP in distinguishing chronic PJI from aseptic failure after knee and hip arthroplasties. Methods From January 2018 to December 2019, we prospectively included patients scheduled to have a revision surgery for chronic PJI or aseptic loosening of an implant, in which synovial CRP was additionally measured along with routine preoperative diagnostic serum and synovial biomarkers. The receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker to determine diagnostic efficacy. Results There were no statistically significant differences in demographic data among the 97 cases we eventually included. the synovial CRP levels were significantly higher in the infection group than in the aseptic group (median: 19 mg/l vs. 9.25 mg/l; p = .001). The optimal cut-off value for detecting chronic PJI of synovial CRP was of 7.26 mg/l with a sensitivity of 84.62%, a specificity of 93.10%. The combined model I (Serum CRP > 10.2 mg/l OR SF CRP > 7.2 6 mg/l) had a negative predictive value (NPV) of 96.67%, and a sensitivity of 97.44%. The combined model II (Serum CRP > 10.2 mg/l AND Synovial CRP > 7.26 mg/l) led to a specificity of 1, and a positive predictive value (PPV) of 1. Conclusion The present study demonstrated that the combination of serum and synovial CRP can be used as an adjunct to the diagnosis of chronic PJI.

scholarly journals Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 829
Author(s):  
Yana Kogan ◽  
Edmond Sabo ◽  
Majed Odeh
Keyword(s):  
Area Under The Curve ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Significant Difference ◽  
Study Population ◽  
Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

Study of predictive value of serum C- reactive protein in diagnosis of acute appendicitis

2021 ◽  
Vol 19 (1) ◽  
pp. 31-34
Author(s):  
Pradeep Chandra Sharma ◽  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Common Finding ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Female Ratio ◽  
Reactive Protein ◽  
Serum Crp

Background: Acute appendicitis is a common surgical condition and the most common cause of acute surgical abdomen. Commonly used tests for diagnosis of acute appendicitis were WBC, CRP ESR and procalcitonin (PCT) levels. In present study we correlated the serum levels of CRP with the histopathology of the removed appendix, to study predictive value of serum C- reactive protein in diagnosis of acute appendicitis. Material and Methods:Present study was conducted in patients with possibility of acute appendicitis, underwent appendicectomy. The histopathology report was considered as the final diagnosis. CRP more than 6 mg/dl was considered to be positive. Results: In present study total 88 patients were included. Male to female ratio was 1.4:1, most common age group was 21-30 years (35.23%) followed by 31-40 years (27.27%). Abdominal pain (92.05%), McBurney tenderness (80.68%), vomiting (76.14%), rebound tenderness (67.05%) and fever (55.68%) were common signs and symptoms noted in present study. On histopathology examination, inflammed appendix (51.14%) was most common finding, others were gangrenous appendix (23.86%), perforated appendix (5.68%) and normal appendix (19.32%). In present study diagnostic efficacy of serum CRP was sensitivity (80%), specificity (84.62%), positive predictive value (96.77%), negative predictive value (42.31%), diagnostic accuracy (80.68%). Conclusion. Serum CRP estimation is useful adjunct in diagnosis of acute appendicitis along with clinical diagnosis. Serum CRP value should be interpreted in combination with clinical findings.

Diagnostic Value of Urine sTREM-1 and Urine C-reactive Protein for Infants with Late Onset Neonatal Sepsis

2019 ◽  
Vol 15 (02) ◽  
pp. 072-078
Author(s):  
Senem Alkan Ozdemir ◽  
Ruya Colak ◽  
Ezgi Yangin Ergon ◽  
Sebnem Calkavur
Keyword(s):  
Neonatal Sepsis ◽  
Predictive Value ◽  
Late Onset ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Late Onset Sepsis ◽  
Noninvasive Markers ◽  
Serum Crp ◽  
Sepsis Detection

Abstract Objective Noninvasive markers have been increasingly used as a diagnostic marker for sepsis detection and monitoring of the disease. The aim of this observational, prospective pilot study was to investigate the diagnostic performance of urinary soluble triggering receptor expressed on myeloid cells (sTREM-1) and urine C-reactive protein (CRP) levels in the late onset neonatal sepsis and to compare them with serum CRP levels. Materials and Methods Sixty-six infants with clinical sepsis were included. Urine sTREM-1 and urine CRP were collected at the diagnosis of late-onset sepsis. All laboratory investigations were also noted from the infants. Results There were no significant differences between characteristics of the infants. Culture-positive neonates had significantly higher urine sTREM-1 than culture-negative neonates (p < 0.001). Using a cut-off point for urine sTREM-1 of 129 pg/mL, the sensitivity was 0.63, the specificity was 0.84, positive predictive value was 0.80, negative predictive value was 0.70. Urine sTREM-1 and urine CRP were recollected on the seventh day of sepsis treatment and it was found that the levels of sTREM-1 and CRP decreased. Conclusion This is the first study in the literature which evaluates the place of urine sTREM-1 and urine CRP in the diagnosis of neonatal sepsis. Urine sTREM-1 and urine CRP may be useful in the diagnosis of sepsis and in evaluating the effect of antibiotic treatment.

scholarly journals Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Cheng Li ◽  
Christina Ojeda Thies ◽  
Chi Xu ◽  
Andrej Trampuz
Keyword(s):  
Meta Analysis ◽  
Joint Infection ◽  
Protein A ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Combined Method ◽  
C Reactive Protein ◽  
Single Marker Analysis ◽  
Gold Standard Method ◽  
Reactive Protein

Abstract Background Because there is no single gold standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection appears to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI. Methods PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019. Results Eight studies were included in the meta-analysis. The pooled sensitivity was 0.84 (95% confidence interval [CI], 0.80−0.88) for the combined method (serum IL-6 and CRP) in series and parallel approaches, 0.87 (95% CI, 0.82−0.90) for IL-6, and 0.84 (95% CI, 0.79−0.88) for CRP. The pooled specificity was 0.85 (95% CI, 0.82−0.88) for the combined method, 0.83 (95% CI, 0.79−0.87) for IL-6, and 0.83 (95% CI, 0.79−0.87) for CRP. The combined method had the highest value for the area under the curve (0.9453), followed by IL-6 (0.9237) and CRP (0.9074). Subgroup analyses showed that the sensitivity of the combined method in parallel tests was higher than that in IL-6 or CRP (94% vs. 89% and 84%, respectively). Serial testing of the combined method showed increased specificity compared to a single indicator (96% vs. 83% and 80%). Conclusion The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of periprosthetic hip and knee infection, demonstrating a better diagnostic accuracy than single marker analysis.

scholarly journals Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

2020 ◽  
Author(s):  
Cheng Li ◽  
Cristina Ojeda Thies ◽  
Chi Xu ◽  
Andrej Trampuz
Keyword(s):  
Meta Analysis ◽  
Joint Infection ◽  
Protein A ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Sample Collection ◽  
Combined Method ◽  
C Reactive Protein ◽  
Gold Standard Method ◽  
Reactive Protein

Abstract Background: Because there is no single gold-standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection seems to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI.Methods: PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019.Results: Eight studies were included in the meta-analysis. The pooled sensitivity was 0.79 (95% confidence interval [CI]: 0.73 to 0.83) for the combined method (serum IL-6 and CRP), 0.87 (95% CI: 0.82 to 0.91) for IL-6 and 0.83 (95% CI: 0.78 to 0.87) for CRP . The pooled specificity was 0.92 (95% CI: 0.89 to 0.95) for the combined method, 0.85 (95% CI: 0.81 to 0.88) for IL-6, and 0.83 (95% CI: 0.79 to 0.87) for CRP. The combined method had the highest value for the area under the curve (0.9688), followed by IL-6 (0.9259) and CRP (0.9139). Subgroup analyses showed that restricting antibiotic treatment before sample collection may improve specificity.Conclusion: The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of PJI, and it had a better diagnostic accuracy than testing with a single marker, especially when samples were collected without antibiotic therapy. Additional research is needed.

scholarly journals Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

2020 ◽  
Author(s):  
Cheng Li ◽  
Cristina Ojeda Thies ◽  
Chi Xu ◽  
Andrej Trampuz
Keyword(s):  
Meta Analysis ◽  
Joint Infection ◽  
Protein A ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Combined Method ◽  
C Reactive Protein ◽  
Single Marker Analysis ◽  
Gold Standard Method ◽  
Reactive Protein

Abstract Background: Because there is no single gold standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection appears to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI.Methods: PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019.Results: Eight studies were included in the meta-analysis. The pooled sensitivity was 0.84 (95% confidence interval [CI]: 0.80−0.88) for the combined method (serum IL-6 and CRP) in series and parallel approaches, 0.87 (95% CI: 0.82−0.90) for IL-6, and 0.84 (95% CI: 0.79−0.88) for CRP. The pooled specificity was 0.85 (95% CI: 0.82−0.88) for the combined method, 0.83 (95% CI: 0.79−0.87) for IL-6, and 0.83 (95% CI: 0.79−0.87) for CRP. The combined method had the highest value for the area under the curve (0.9453), followed by IL-6 (0.9237) and CRP (0.9074). Subgroup analyses showed that the sensitivity of the combined method in parallel tests was higher than IL-6 or CRP (94% vs. 89% and 84%, respectively). Serial testing of the combined method showed increased specificity compared to a single indicator (96% vs. 83% and 80%).Conclusion: The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of periprosthetic hip and knee infection, demonstrating a better diagnostic accuracy than single marker analysis. However, further research is required to confirm current results.

scholarly journals The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection

2021 ◽  
Author(s):  
Doruk Akgün ◽  
Mats Wiethölter ◽  
Paul Siegert ◽  
Victor Danzinger ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Joint Infection ◽  
Receiver Operating Curve ◽  
C Reactive Protein ◽  
Level Of Evidence ◽  
Reactive Protein ◽  
Median Serum ◽  
Cutibacterium Acnes ◽  
Serum Crp ◽  
Receiver Operating

Abstract Introduction There is a paucity of literature regarding serum C-reactive protein (CRP) in the evaluation of a shoulder periprosthetic joint infection (PJI). The purpose of the current study was to establish cutoff values for diagnosing shoulder PJI and evaluate the influence of the type of infecting microorganism and the classification subgroups according to last proposed International Consensus Meeting (ICM) criteria on the CRP level. Materials and methods A retrospective analysis of all 136 patients, who underwent septic or aseptic revision shoulder arthroplasty in our institution between January 2010 and December 2019, was performed. Shoulder PJI was defined according to the last proposed definition criteria of the ICM. Serum CRP levels were compared between infected and non-infected cases, between infection subgroups, as well as between different species of infecting microorganisms. A receiver-operating characteristic (ROC) analysis was performed to display sensitivity and specificity of serum CRP level for shoulder PJI. Results A total of 52 patients (38%) were classified as infected, 18 meeting the criteria for definitive infection, 26 for probable infection and 8 for possible infection. According to the ROC curve, an optimized serum CRP threshold of 7.2 mg/l had a sensitivity of 69% and specificity of 74% (area under curve = 0.72). Patients with definitive infection group demonstrated significantly higher median serum CRP levels (24.3 mg/l), when compared to probable, possible infection groups and PJI unlikely group (8 mg/l, 8.3 mg/l, 3.6 mg/l, respectively, p < 0.05). The most common isolated microorganism was Cutibacterium acnes in 25 patients (48%) followed by coagulase-negative staphylococci (CNS) in 20 patients (39%). Patients with a PJI caused by high-virulent microorganisms had a significantly higher median serum CRP level compared to patients with PJI caused by low-virulent microorganisms (48 mg/l vs. 11.3 mg/l, p = 0.04). Conclusions Serum CRP showed a low sensitivity and specificity for the diagnosis of shoulder PJI, even applying cutoffs optimized by receiver-operating curve analysis. Low-virulent microorganisms and patients with probable and possible infections are associated with lower CRP levels compared to patients with definitive infection and infections caused by high-virulent microorganisms. Level of evidence Diagnostic Level III.

scholarly journals Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

2020 ◽  
Vol 5 (2) ◽  
pp. 89-95 ◽  
Author(s):  
Pascale Bémer ◽  
Céline Bourigault ◽  
Anne Jolivet-Gougeon ◽  
Chloé Plouzeau-Jayle ◽  
Carole Lemarie ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Serological Test ◽  
Bacterial Species ◽  
Joint Infection ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Cutibacterium Acnes

Abstract. Introduction: The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening.Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines.Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes.Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

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