• Hong Xu, Jinwei Xie, Xufeng Wan, Li Liu, Duan Wang, and Zongke Zhou.
• Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
• Chin. Med. J. 2022 Aug 20; 135 (16): 198619921986-1992.

BackgroundThe screening of periprosthetic joint infection (PJI) in patients with inflammatory diseases before revision arthroplasty remains uncertain. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen (FIB), monocyte/lymphocyte ratio, and neutrophil/lymphocyte ratio (NLR) can help screening PJI, but their values in patients with inflammatory diseases have not been determined.MethodsPatients with inflammatory diseases who underwent revision hip or knee arthroplasty at West China Hospital, Sichuan University, from January 2008 to September 2020 were divided into infected and non-infected groups based on the 2013 International Consensus Meeting criteria. Sensitivity and specificity of the tested biomarkers for diagnosing infection were determined based on receiver operating characteristic (ROC) curves, and optimal cutoffs were determined based on the Youden index. The diagnostic ability of these biomarkers was re-assessed after combining them with each other.ResultsA total of 62 patients with inflammatory diseases were studied; of them 30 were infected. The area under the ROC curve was 0.813 for CRP, 0.638 for ESR, 0.795 for FIB, and 0.656 for NLR. The optimal predictive cutoff of CRP was 14.04 mg/L with a sensitivity of 86.2% and a specificity of 68.7%, while FIB had a sensitivity of 72.4% and a specificity of 81.2% with the optimal predictive cutoff of 4.04 g/L. The combinations of CRP with FIB produced a sensitivity of 86.2% and specificity of 78.1%.ConclusionCRP with a slightly higher predictive cutoff and FIB are useful for screening PJI in patients with inflammatory diseases, and the combination of CRP and FIB may further improve the diagnostic values.Trial RegistrationChiCTR.org.cn, ChiCTR2000039989.Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

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