Biomedical papers, 2017 (vol. 161), issue 3

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017, 161(3):310-319 | 10.5507/bp.2017.021

Excellent AUC for joint fluid cytology in the detection/exclusion of hip and knee prosthetic joint infection

Jiri Galloa, Jarmila Juranovab, Michal Svobodaa, Jana Zapletalovac
a Department of Orthopaedics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
b Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palackyý University Olomouc, Czech Republic
c Department of Medical Biophysics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Background and Aim. The aim of this study was to evaluate the characteristics of synovial fluid (SF) white cell count (SWCC) and neutrophil/lymphocyte percentage in the diagnosis of prosthetic joint infection (PJI) for particular threshold values.

Methods and Results: This was a prospective study of 391 patients in whom SF specimens were collected before total joint replacement revisions. SF was aspirated before joint capsule incision. The PJI diagnosis was based only on non-SF data. Receiver operating characteristic plots were constructed for the SWCC and differential counts of leukocytes in aspirated fluid. Logistic binomic regression was used to distinguish infected and non-infected cases in the combined data. PJI was diagnosed in 78 patients, and aseptic revision in 313 patients. The areas (AUC) under the curve for the SWCC, the neutrophil and lymphocyte percentages were 0.974, 0.962, and 0.951, respectively. The optimal cut-off for PJI was 3,450 cells/μL, 74.6% neutrophils, and 14.6% lymphocytes. Positive likelihood ratios for the SWCC, neutrophil and lymphocyte percentages were 19.0, 10.4, and 9.5, respectively. Negative likelihood ratios for the SWCC, neutrophil and lymphocyte percentages were 0.06, 0.076, and 0.092, respectively.

Conclusions: Based on AUC, the present study identified cut-off values for the SWCC and differential leukocyte count for the diagnosis of PJI. The likelihood ratio for positive/negative SWCCs can significantly change the pre-test probability of PJI.

Keywords: prosthetic joint infection, synovial white cell count, neutrophil percentage, lymphocyte percentage, ROC curves

Received: January 4, 2017; Accepted: April 20, 2017; Prepublished online: May 15, 2017; Published: September 26, 2017


References

  1. Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint I. Definition of periprosthetic joint infection. J Arthroplasty 2014;29(7):1331. Go to original source... Go to PubMed...
  2. Esteban J, Sorli L, Alentorn-Geli E, Puig L, Horcajada JP. Conventional and molecular diagnostic strategies for prosthetic joint infections. Expert Rev Mol Diagn 2014;14(1):83-96. Go to original source... Go to PubMed...
  3. Piper KE, Fernandez-Sampedro M, Steckelberg KE, Mandrekar JN, Karau MJ, Steckelberg JM, Berbari EF, Osmon DR, Hanssen AD, Lewallen DG, Cofield RH, Sperling JW, Snachez-Sotelo J, Huddleston PM, Dekutoski MB, Yaszemski M, Currier B, Patel R. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS One 2010;5(2):e9358. Go to original source... Go to PubMed...
  4. Parvizi J, Alijanipour P, Barberi EF, Hickok NJ, Phillips KS, Shapiro IM, Schwarz EM, Stevens MH, Wang Y, Shirtliff ME. Novel developments in the prevention, diagnosis, and treatment of periprosthetic joint infections. J Am Acad Orthop Surg 2015;23 Suppl:S32-43. Go to original source... Go to PubMed...
  5. Parvizi J, Della Valle CJ. AAOS Clinical Practice Guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 2010;18(12):771-2. Go to original source... Go to PubMed...
  6. Borens O, Corvec S, Trampuz A. Diagnosis of periprosthetic joint infections. Hip Int 2012;22 Suppl 8:S9-14. Go to original source... Go to PubMed...
  7. Qu X, Zhai Z, Liu X, Li H, Wu C, Li Y, Li H, Zhu Z, Qin A, Dai K. Evaluation of white cell count and differential in synovial fluid for diagnosing infections after total hip or knee arthroplasty. PLoS One 2014;9(1):e84751. Go to original source... Go to PubMed...
  8. Gallo J, Kolar M, Dendis M, Loveckova Y, Sauer P, Zapletalova J, Koukalova D. Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection. New Microbiol 2008;31(1):97-104. Go to PubMed...
  9. Trampuz A, Zimmerli W. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly 2005;135(17-18):243-51. Go to PubMed...
  10. Holinka J, Bauer L, Hirschl AM, Graninger W, Windhager R, Presterl E. Sonication cultures of explanted components as an add-on test to routinely conducted microbiological diagnostics improve pathogen detection. J Orthop Res 2011;29(4):617-22. Go to original source... Go to PubMed...
  11. Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 1998;36(10):2932-9.
  12. Mirra JM, Amstutz HC, Matos M, Gold R. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res 1976(117):221-40.
  13. Luo J, Xiong C. Youden index and Associated Cut-points for Three Ordinal Diagnostic Groups. Commun Stat Simul Comput 2013;42(6):1213-1234. Go to original source... Go to PubMed...
  14. Dinneen A, Guyot A, Clements J, Bradley N. Synovial fluid white cell and differential count in the diagnosis or exclusion of prosthetic joint infection. Bone Joint J 2013;95-B(4):554-7. Go to original source... Go to PubMed...
  15. Spangehl MJ, Masri BA, O'Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am 1999;81(5):672-83. Go to original source... Go to PubMed...
  16. Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am 2008;90(8):1637-43. Go to original source... Go to PubMed...
  17. Cipriano CA, Brown NM, Michael AM, Moric M, Sporer SM, Della Valle CJ. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am 2012;94(7):594-600. Go to original source... Go to PubMed...
  18. Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am 2008;90(9):1869-75. Go to original source... Go to PubMed...
  19. Yi PH, Cross MB, Moric M, Sporer SM, Berger RA, Della Valle CJ. The 2013 Frank Stinchfield Award: Diagnosis of infection in the early postoperative period after total hip arthroplasty. Clin Orthop Relat Res 2014;472(2):424-9. Go to original source... Go to PubMed...
  20. Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH, Bossuyt PM. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999;282(11):1061-6. Go to original source... Go to PubMed...
  21. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF, for the STARD group. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015;351:h5527. Go to original source... Go to PubMed...
  22. Pepe MS, Thompson ML. Combining diagnostic test results to increase accuracy. Biostatistics 2000;1(2):123-40. Go to original source... Go to PubMed...
  23. Furukawa TA, Strauss, S.E., Bucher, H.C., Agoritsas, T., Guyatt, G. Diagnostic tests. Guyatt G, editor. New York: McGraw-Hill Professional; 2014. 345-357 p.
  24. Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003;56(11):1129-35. Go to original source... Go to PubMed...
  25. Li J, Fine JP. ROC analysis with multiple classes and multiple tests: methodology and its application in microarray studies. Biostatistics 2008;9(3):566-76. Go to original source... Go to PubMed...