Diagnostic Accuracy of Neutrophil Gelatinase-associated Lipocalin (NGAL) in Periprosthetic Joint Infection: A Meta-analysis

Abstract

Abstract Background: Periprosthetic joint infection(PJI) is a catastrophic complication after arthroplasty and is currently challenging to diagnose. A large number of diagnostic biomarkers have been used for the diagnosis of PJI. Neutrophil gelatinase-associated lipocalin(NGAL) is a novel diagnostic biomarker for PJI, and its diagnostic efficacy remains to be investigated. The purpose of this study is to investigate the value of NGAL in the diagnosis of PJI. Methods: Six databases, including Cochrane Library, Scopus, OVID, PubMed, Web of Science, and Embase, were searched for literature related to NGLA in the PJI diagnosis from the inception to December 25, 2022. The diagnostic accuracy of NGAL was evaluated by pooled sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), diagnostic odds ratio(DOR), and the area under the summarized receiver operating characteristic curve(AUSROC). Results: A total of seven studies were included in the meta-analysis, with 201 PJIs and 299 aseptic revisions. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUSROC of NGLA were 0.93(95%CI, 0.88-0.96), 0.93(95%CI, 0.89-0.96), 13.65(95%CI, 4.64-40.18), 0.09(95%CI, 0.04-0.21), 202.89(95%CI, 39.00-1055.53), 0.973, respectively. Conclusion: This study shows that NGLA is an excellent diagnostic biomarker for diagnosing PJI. NGLA can be applied to the clinical diagnosis of PJI in the future.