Serum albumin-to-globulin ratio and CRP-to-albumin ratio did not outperform serum CRP in diagnosing periprosthetic joint infections

Author:

Luger Markus1ORCID,Böhler Christoph1,Puchner Stephan E.1,Apprich Sebastian1,Staats Kevin1ORCID,Windhager Reinhard1,Sigmund Irene K.1ORCID

Affiliation:

1. Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria

Abstract

AimsSerum inflammatory parameters are widely used to aid in diagnosing a periprosthetic joint infection (PJI). Due to their limited performances in the literature, novel and more accurate biomarkers are needed. Serum albumin-to-globulin ratio (AGR) and serum CRP-to-albumin ratio (CAR) have previously been proposed as potential new parameters, but results were mixed. The aim of this study was to assess the diagnostic accuracy of AGR and CAR in diagnosing PJI and to compare them to the established and widely used marker CRP.MethodsFrom 2015 to 2022, a consecutive series of 275 cases of revision total hip (n = 129) and knee arthroplasty (n = 146) were included in this retrospective cohort study. Based on the 2021 European Bone and Joint Infection Society (EBJIS) definition, 144 arthroplasties were classified as septic. Using receiver operating characteristic curve (ROC) analysis, the ideal thresholds and diagnostic performances were calculated. The areas under the curve (AUCs) were compared using the z-test.ResultsAGR, CAR, and CRP were associated with PJI (p < 0.001). Sensitivities were 62.5% (95% CI 54.3 to 70.0), 73.6% (95% CI 65.8 to 80.1), and 71.5% (95% CI 63.6 to 78.3), respectively. Specificities were calculated with 84.7% (95% CI 77.5 to 89.9), 86.3% (95% CI 79.2 to 91.2), and 87.8% (95% CI 80.9 to 92.4), respectively. The AUC of CRP (0.797 (95% CI 0.750 to 0.843)) was significantly higher than the AUC of AGR (0.736 (95% CI 0.686 to 0.786), p < 0.001), and similar to AUC of CAR (0.799 (95% CI 0.753 to 0.846), p = 0.832). Decreased sensitivities were observed in PJIs caused by low-virulence organisms (AGR: 60%, CAR: 78%) compared to high-virulence pathogens (AGR: 80%, p = 0.042; CAR: 88%, p = 0.158). Higher sensitivities were seen in acute haematogenous (AGR: 83%, CAR: 96%) compared to chronic PJIs (AGR: 54%, p = 0.001; CAR: 65%, p < 0.001).ConclusionSerum AGR and CAR showed limited diagnostic accuracy (especially in low-grade and chronic infections) and did not outperform the established marker CRP in our study. Hence, neither parameter can be recommended as an additional tool for diagnosing PJI.Cite this article: Bone Joint Res 2024;13(8):372–382.

Publisher

British Editorial Society of Bone & Joint Surgery

Reference32 articles.

1. Periprosthetic joint infection: current concepts and outlook;Izakovicova;EFORT Open Rev,2019

2. The EBJIS definition of periprosthetic joint infection;McNally;Bone Joint J,2021

3. No authors listed . Evidence-Based Clinical Practice Guideline for Diagnosis and Prevention of Periprosthetic Joint Infections . American Academy of Orthopaedic Surgeons . 2019 . https://www.aaos.org/quality/quality-programs/tumor-infection-and-military-medicine-programs/diagnosis--prevention-of-periprosthetic-joint-infections/ ( date last accessed 26 June 2024 ).

4. Serum inflammatory biomarkers in the diagnosis of periprosthetic joint infections;Sigmund;Biomedicines,2021

5. Acute-phase proteins and other systemic responses to inflammation;Gabay;N Engl J Med,1999

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