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Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection.
BMC Musculoskelet Disord. 2020 Oct 27; 21(1):706.BM

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.

Authors+Show Affiliations

Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China. Department of Orthopaedics, Bao Ding GemFlower Eastern Hospital, Bao Ding, Hebei, P. R. China.Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China.Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China.Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China. haolibo301@163.com.Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China. jiyingchen_301@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33109144

Citation

Yu, Bao-Zhan, et al. "Neutrophil to Lymphocyte Ratio as a Predictor for Diagnosis of Early Periprosthetic Joint Infection." BMC Musculoskeletal Disorders, vol. 21, no. 1, 2020, p. 706.
Yu BZ, Fu J, Chai W, et al. Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection. BMC Musculoskelet Disord. 2020;21(1):706.
Yu, B. Z., Fu, J., Chai, W., Hao, L. B., & Chen, J. Y. (2020). Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection. BMC Musculoskeletal Disorders, 21(1), 706. https://doi.org/10.1186/s12891-020-03704-5
Yu BZ, et al. Neutrophil to Lymphocyte Ratio as a Predictor for Diagnosis of Early Periprosthetic Joint Infection. BMC Musculoskelet Disord. 2020 Oct 27;21(1):706. PubMed PMID: 33109144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection. AU - Yu,Bao-Zhan, AU - Fu,Jun, AU - Chai,Wei, AU - Hao,Li-Bo, AU - Chen,Ji-Ying, Y1 - 2020/10/27/ PY - 2020/04/19/received PY - 2020/10/05/accepted PY - 2020/10/28/entrez PY - 2020/10/29/pubmed PY - 2020/10/29/medline KW - C-reactive protein KW - Early periprosthetic joint infection KW - Interleukin-6 KW - Neutrophil to lymphocyte ratio SP - 706 EP - 706 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 21 IS - 1 N2 - 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. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/33109144/Neutrophil_to_lymphocyte_ratio_as_a_predictor_for_diagnosis_of_early_Periprosthetic_joint_infection L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03704-5 DB - PRIME DP - Unbound Medicine ER -
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