Changes in serum markers failed to predict persistent infection after two-stage exchange arthroplasty

Abstract BackgroundTwo-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in first stage, the proper timing of reimplantation is crucial for successful treatment. So far, there is no gold reference to determine the eradication of PJI before reimplantation. The combination of serum indicators, synovial white cell count (WBC), culture results, intraoperative histology, and clinical symptoms is used extensively to guide the timing of reimplantation. However, the proper timing of reimplantation was ill defined.PurposeWe wonder: (1) the utility of serum indicators, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, when predicted failure of reimplantation; (2) correlation between primary culture results and serum markers’ change.MethodA retrospective review of 226 patients treated with a two-stage exchange arthroplasty from 2014 to 2017 was conducted. PJI was diagnosed by using the Musculoskeletal Infection Society (MSIS) criteria. Serum biomarkers and organisms results at the set of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 year; receiver operator characteristic (ROC) depicted the utility of change in four serum markers when predicted failure.ResultsThe ROC area under the curves (AUC) was 0.543 in CRP, 0.572 in IL-6, 0.621 in ESR, 0.463 in fibrinogen and the combination of them was 0.709 when predicted persistent PJI using value change. The AUC of ROC was 0.521 in CRP, 0.472 in IL-6, 0.413 in ESR, 0.552 in fibrinogen and the combination was 0.630 when determine reimplantation by percent change. No significant association was found between culture results and change in serum markers.ConclusionNeither percent change nor value change in serum makers was proved to be poor markers when predicted persistent PJI, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still tough to diagnose. The combination of clinical symptom, pathology results, synovial fluid analysis and serum markers may improve the utility.

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Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

10.21203/rs.3.rs-33168/v2 ◽

2020 ◽

Author(s):

Qiao Jiang ◽

Jun Fu ◽

Wei Chai ◽

Li-bo Hao ◽

Yong-Gang Zhou ◽

...

Keyword(s):

Persistent Infection ◽

Treatment Success ◽

Serum Markers ◽

Two Stage ◽

International Consensus ◽

Variation Trend ◽

Reactive Protein ◽

Proper Timing ◽

Significant Difference ◽

Value Changes

Abstract Background The proper timing of reimplantation is importation to treatment success in two-stage exchange revision. The 2018 International Consensus Meeting suggested that a variation trend toward normalization in serum markers was useful for determining the proper timing of reimplantation. However, the opposite results were found that by previous studies, and the normalization of serum markers was reported to fail to predict infection control. We investigated whether value changes and percent changes in four common serum markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen) can predict persistent infection?Methods A retrospective review of 141 patients treated with two-stage revision from 2014 to 2018 was conducted. The variation trend in serum indicators was evaluated by the percent changes (using values of serum markers prereimplantation divided by values preresection) and value changes (using values of serum markers preresection minus values prereimplantation). Treatment success was defined according to the Delphi-based consensus criteria with a minimum follow-up of 1 year, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in serum markers.Results 22 patients (15.60%) were persistently infected. No significant difference was found in either the value change or percent change in serum markers between reinfection and non-reinfection patients. When predicting persistent infection, the area under the curves (AUC) demonstrated that both percent changes and value changes in serum markers were poor indicators. The AUC of value changes was 0.533 for the CRP, 0.504 for the IL-6, 0.508 for the ESR and 0.586 for fibrinogen when predicted persistent PJI. In addition, the AUC indicated that percent changes in the CRP (0.464), the IL-6 (0.534), the ESR (0.527) and fibrinogen (0.586) were all poor markers.Conclusions We have shown that both value changes and percent changes in serum markers were not sufficiently rigorous to aid in persistent infection diagnosis. The proper timing of reimplantation must therefore take into account various clinical tests rather than the downward trend of serum markers only.

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Two-stage exchange Arthroplasty is a viable treatment for Periprosthetic joint infection in inflammatory diseases

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03701-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Qiao Jiang ◽

Jun Fu ◽

Wei Chai ◽

Li-Bo Hao ◽

Yong-Gang Zhou ◽

...

Keyword(s):

Synovial Fluid ◽

Inflammatory Diseases ◽

Joint Infection ◽

Treatment Success ◽

Serum Markers ◽

Control Group ◽

Two Stage ◽

Fluid Analysis ◽

Exchange Arthroplasty ◽

Prosthetic Joint

Abstract Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases. Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8 ± 1385.3*109/mL) and group C (1315.8 ± 1849.3*109/mL, p = 0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group. Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

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Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

10.21203/rs.2.20070/v2 ◽

2020 ◽

Author(s):

Qiao Jiang ◽

Xue Yang ◽

Chi Xu ◽

Wei Chai ◽

Yong-gang Zhou ◽

...

Keyword(s):

Serum Markers ◽

Serum Biomarkers ◽

Causative Organism ◽

Value Change ◽

Two Stage ◽

Musculoskeletal Infection ◽

Percent Change ◽

Proper Timing ◽

Exchange Arthroplasty

Abstract Background Two-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in the first stage, the proper timing of reimplantation is crucial for successful treatment. To date, there is no gold standard to evaluate the eradication of PJI before reimplantation. A combination of serum indicators, synovial blood white cell (WBC) counts, culture results, intraoperative histology, and clinical symptoms is wildly used to guide the timing of reimplantation. However, the proper timing of reimplantation is not clearly defined. We investigated whether: (1) serum indicators, which included the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, were useful indicators for predicting the failure of reimplantation; and (2) primary culture results were related to serum marker changes? Method A retrospective review of 109 patients treated with two-stage exchange arthroplasty from 2014 to 2017 was conducted. The inclusion criteria included the following: 1. a minimum of a 2-year follow-up or failure of treatment within this period; 2. complete record of serum biomarkers; and 3. met the Musculoskeletal Infection Society criteria (MSIS) when diagnosed PJI. Serum biomarkers and organism results at the onset of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 years, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in four serum markers for predicting failure. Results When predicting persistent PJI, the area under the ROC curves (AUC) demonstrated that both the percent change and value change of serum markers were poor indicators. When comparing exact values of serum markers during reimplantation, the values of CRP and fibrinogen were significant higher in reinfection group. Besides, initial causative organism didn’t influence the normalize of serum markers. Conclusion Either the value change or percent change of serum markers were not useful for determining the timing of reimplantation, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still difficult to diagnose.

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Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

10.21203/rs.3.rs-33168/v1 ◽

2020 ◽

Author(s):

Qiao Jiang ◽

Jun Fu ◽

Wei Chai ◽

Li-bo Hao ◽

Yong-Gang Zhou ◽

...

Keyword(s):

Persistent Infection ◽

Treatment Success ◽

Serum Markers ◽

Two Stage ◽

International Consensus ◽

Variation Trend ◽

Reactive Protein ◽

Proper Timing ◽

Significant Difference ◽

Value Changes

Abstract Background The 2018 International Consensus Meeting suggested that a variation trend toward normalization in serum markers was useful for determining the proper timing of reimplantation. However, the opposite results were found that by previous studies, and the normalization of serum markers was reported to fail to predict infection control. We investigated whether value changes and percent changes in four common serum markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen) can predict persistent infection? Methods A retrospective review of 141 patients treated with two-stage revision from 2014 to 2018 was conducted. The variation trend in serum indicators was evaluated by the percent changes (using values of serum markers prereimplantation divided by values preresection) and value changes (using values of serum markers preresection minus values prereimplantation). Treatment success was defined according to the Delphi-based consensus criteria with a minimum follow-up of 1 year, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in serum markers. Results 22 patients (15.60%) were persistently infected. No significant difference was found in either the value change or percent change in serum markers between reinfection and non-reinfection patients. When predicting persistent infection, the area under the curves (AUC) demonstrated that both percent changes and value changes in serum markers were poor indicators. The AUC of value changes was 0.533 for the CRP, 0.504 for the IL-6, 0.508 for the ESR and 0.586 for fibrinogen when predicted persistent PJI. In addition, the AUC indicated that percent changes in the CRP (0.464), the IL-6 (0.534), the ESR (0.527) and fibrinogen (0.586) were all poor markers. Conclusions We have shown that both value changes and percent changes in serum markers were not sufficiently rigorous to aid in persistent infection diagnosis. The proper timing of reimplantation must therefore take into account various clinical tests rather than the downward trend of serum markers only.

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Two-stage Exchange Arthroplasty is a Viable Treatment for Periprosthetic Joint Infection in Inflammatory Diseases

10.21203/rs.2.22348/v3 ◽

2020 ◽

Author(s):

Qiao Jiang ◽

Jun Fu ◽

Wei Chai ◽

Li-Bo Hao ◽

Yong-Gang Zhou ◽

...

Keyword(s):

Synovial Fluid ◽

Inflammatory Diseases ◽

Joint Infection ◽

Treatment Success ◽

Serum Markers ◽

Control Group ◽

Two Stage ◽

Fluid Analysis ◽

Exchange Arthroplasty ◽

Prosthetic Joint

Abstract Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases.Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8±1385.3*109/mL) and group C (1315.8±1849.3*109/mL, p=0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group.Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

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Plasma fibrinogen may predict persistent infection before reimplantation in two-stage exchange arthroplasty for periprosthetic hip infection

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1179-9 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 11

Author(s):

Chi Xu ◽

Peng-Fei Qu ◽

Wei Chai ◽

Rui Li ◽

Ji-Ying Chen

Keyword(s):

Persistent Infection ◽

Plasma Fibrinogen ◽

Two Stage ◽

Exchange Arthroplasty ◽

Hip Infection

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Two-stage Exchange Arthroplasty is a Viable Treatment for Periprosthetic Joint Infection in Inflammatory Diseases

10.21203/rs.2.22348/v2 ◽

2020 ◽

Author(s):

Qiao Jiang ◽

Jun Fu ◽

Wei Chai ◽

Li-Bo Hao ◽

Yong-Gang Zhou ◽

...

Keyword(s):

Synovial Fluid ◽

Inflammatory Diseases ◽

Joint Infection ◽

Treatment Success ◽

Serum Markers ◽

Control Group ◽

Two Stage ◽

Fluid Analysis ◽

Exchange Arthroplasty ◽

Prosthetic Joint

Abstract Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases. Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8±1385.3*10 9 /mL) and group C (1315.8±1849.3*10 9 /mL, p=0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group. Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

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