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

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03704-5 ◽

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.

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

10.21203/rs.3.rs-23878/v4 ◽

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

10.21203/rs.3.rs-23878/v3 ◽

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

10.21203/rs.3.rs-23878/v2 ◽

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. Thediagnosis 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 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 8.2X10 9 /L and 6.1 X10 9 /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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Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

10.21203/rs.3.rs-16770/v1 ◽

2020 ◽

Author(s):

BaoZhan Yu ◽

Jun Fu ◽

Wei Chai ◽

Libo Hao ◽

Jiying Chen

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Neutrophil To Lymphocyte Ratio ◽

Optimal Cutoff ◽

Predictive Values ◽

Musculoskeletal Infection ◽

Cutoff Value ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Total Knee

Abstract Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty (TJA). 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 the diagnosis of infection. The purpose of this study was to determine the accuracy of the NLR in the diagnosis of early PJI after total knee or hip joint arthroplasty.Methods: We retrospectively reviewed 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 based on the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters (C-reactive protein, erythrocyte sedimentation rate, white blood-cell count, NLR, interleukin-6 levels) were compared between the two groups. Receiver operating characteristic curves were generated to determine the optimal cutoff values for each parameter. Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. Results: The CRP, ESR, WBC, NLR and IL-6 values were all elevated in the infected group compared to the uninfected group. The mean CRP (infected=59.06, uninfected=10.09), ESR (infected=35, uninfected=17), WBC(infected=7.95x109,uninfected=6.16x109), NLR (infected=4.89, uninfected=2.18), IL-6 (infected=40.68, uninfected=7.46). All values were significant difference between the two groups. The best test for the diagnosis of early PJI was IL-6 (AUC=81.4%; optimal cutoff value 8.07pg/ml) followed by the NLR (AUC =80.2%; optimal cutoff value 2.13), CRP (AUC =79.3%; optimal cutoff value 9.27mg/l), ESR (AUC =74.4%; optimal cutoff value 22mm/h) and WBC (AUC = 63.2%; optimal cutoff value 8.91x109). 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 an easy, cheap and convenient parameters to be calculated in daily practice without extra costs.

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

10.21203/rs.2.20200/v1 ◽

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.

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