Authors: Berbari EF, Mabry T, Tsaras G, Spangehl M, ErwinPJ, Steckelberg J, Hassan MH, Osmon DR, Mayo clinic, Rochester, MN
Title: Inflammatory Blood Laboratory Levels as Markers of Prosthetic Joint Infection(PJI): A Systematic Review and Meta-analysis
Purpose: To summarize evidence on the accuracy of commonly used systemic inflammation markers such as erythrocyte sedimentation rate (ESR), C reactive protein ( CRP), Interleukin 6 (IL6) and procalcitonin (PCT) for the diagnosis of PJI
Methods: We searched electronic databases (Ovid MEDLINE, Ovid EMBASE, Cochrane Library, Web of Science, and Scopus) from 1950 till 1/31/2009. Eligible studies reported on the accuracy of peripheral white blood cell count, blood ESR, plasma CRP, IL6 and PCT vs the intraoperative diagnosis of prosthetic joint infection at the time of revision arthroplasty. Two reviewers working independently extracted study characteristics and data to estimate likelihood ratio (LR) and 95% confidence interval (CI) for each result. We found 30 eligible studies including 3909 revision THA or TKA.
Results: The prevalence of PJI in included studies was 32.5% (1270/3909). The accuracy of IL6 was (n = 3 studies; PLR 10.3, CI 7.1-15; NLR 0.033, CI 0.01-0.08), for CRP (n = 22 studies; PLR 3.3, CI 2.4-4.5; NLR 0.17, CI 0.1-0.27); for ESR n = 23 studies; PLR 2.7, CI 2.1-3.6; NLR 0.34, CI 0.23-0.51) and for WBC (n = 14 studies; PLR 2.6, CI 1.8-3.8; NLR 0.72, CI 0.6-0.8). The diagnostic accuracy for WBC, ESR and CRP was better for TKA than for THA.
Discuassion and Conclusion: WBC, ESR and CRP tests used in the diagnosis of PJI appears to have low accuracy. IL6 appears to have a better accuracy for the diagnosis of PJI.