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

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.

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

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.

scholarly journals Change in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange ArthroplastyChange in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

2020 ◽  
Author(s):  
Qiao Jiang ◽  
Xue Yang ◽  
Chi Xu ◽  
Wei Chai ◽  
Yong-gang Zhou ◽  
...  
Keyword(s):  
Persistent Infection ◽  
Treatment Success ◽  
Serum Markers ◽  
Causative Organism ◽  
Value Change ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Percent Change ◽  
Proper Timing ◽  
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.

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

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Qiao Jiang ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-bo Hao ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Persistent Infection ◽  
Serum Markers ◽  
Two Stage ◽  
Exchange Arthroplasty

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

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.

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

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.

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

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.

scholarly journals Does serum interleukin-6 guide the diagnosis of persistent infection in two-stage hip revision for periprosthetic joint infection?

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Peng-Fei Qu ◽  
Chi Xu ◽  
Jun Fu ◽  
Rui Li ◽  
Wei Chai ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Interleukin 6 ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Roc Curves ◽  
Two Stage ◽  
Predictive Values ◽  
Musculoskeletal Infection ◽  
Significant Difference

Abstract Purpose The diagnosis of persistent infection at reimplantation of two-stage revision arthroplasty for periprosthetic joint infection (PJI) remains challenging. Several studies have shown the benefit of serum interleukin-6 (IL-6) in diagnosing periprosthetic joint infection (PJI). Recent data indicated serum IL-6 could be promising in differentiating persistent infection. The purpose of this study was to validate the efficacy of serum IL-6 in diagnosing persistent infection at reimplantation. Methods A retrospective review of 86 PJI patients with a two-stage exchanged hip arthroplasty from 2013 to 2017 was conducted. Persistent infection was defined using the modified Musculoskeletal Infection Society (MSIS) criteria combined with follow-up results. Serum IL-6 at reimplantation were collected and compared among patients with or without persistent infection. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic performance and optimal cut-off value of serum IL-6 at reimplantation. Results Sixteen cases were diagnosed as persistent infection at reimplantation. There was no significant difference in serum IL-6 levels between cases with persistent infection and controls (7.89 pg/ml vs. 5.56 pg/ml; P = 0.179). The area under the ROC curve (AUC) for serum IL-6 in diagnosing persistent infection at reimplantation was 0.59 (95% confidential interval [CI] 0.40–0.77). With the calculated threshold set at 8.12 pg/ml, the corresponding sensitivity, specificity, positive predictive value, and negative predictive values were 38%, 88%, 38%, and 87%, respectively. Conclusion Serum IL-6 is inadequate in diagnosing persistent infection at reimplantation for two-stage revision arthroplasty. With the serum IL-6 threshold set at 8.12 pg/ml, the specificity to rule out persistent infection is high, but the sensitivity to predict persistent infection is not satisfactory.

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

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.

scholarly journals Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein in Tension-Type Headache Patients

2021 ◽  
Author(s):  
Hasan Hüseyin Özdemir ◽  
Ahmet Dönder
Keyword(s):  
Systemic Inflammation ◽  
Tension Type Headache ◽  
Neutrophil To Lymphocyte Ratio ◽  
Control Group ◽  
C Reactive Protein ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Significant Difference ◽  
Type Headache

Abstract Objectives A tension headache is the most common type of headache, and its causes are multifactorial. A relationship has been shown between migraine headaches and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). In this study, we investigated the NLR, PLR, and serum CRP levels in frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH) patients. Materials and Methods This retrospective study included 64 patients with FETTH, 80 patients with CTTH, and 60 healthy controls who were followed up in the neurology clinic. Hematological parameters were compared between the patient and control groups. Results In CTTH patients, platelets, NLR, PLR, and CRP values were statistically higher than in FETTH patients and patients in the control group. In FETTH patients, the PLR value was higher than in patients in the control group, but there was no statistically significant difference in NLR and CRP values between FETTH patients and patients in the control group. Also, there was no correlation between these values and age and gender. Conclusion Increase platelet count might have an effect on tension-type headache pathophysiology. Systemic inflammation parameters were shown to be significantly higher in CTTH patients. More comprehensive studies are needed to evaluate the effect of systemic inflammation on the chronicity of tension headaches.

scholarly journals The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hao Li ◽  
Rui Li ◽  
L. L. Li ◽  
Wei Chai ◽  
Chi Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Periprosthetic Joint Infection ◽  
Retrospective Cohort Study ◽  
Persistent Infection ◽  
Retrospective Cohort ◽  
Joint Infection ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Coagulation Profile ◽  
Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

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