ABSTRACT

Background: Leukocyte esterase (LE) and α-defensin (AD) are two synovial biomarkers that are used for the diagnosis of periprosthetic joint infection (PJI), however, the superiority of one over the other remains unknown. We aimed to compare their diagnostic value.

Methods: In this retrospective study, we evaluated patients who underwent revision total hip and knee arthroplasty at a single institution between 2013 and 2019 for whom both LE and AD were available. PJI was defined by the 2018 International Consensus Meeting criteria. The diagnostic performance of AD and LE was compared.

Results: Overall, 122 patients (28 PJI and 94 aseptic revisions) were included. The area under the curve was 0.905 (95% confidence interval[CI]:0.820–0.991) and 0.913 [95%CI:0.834–0.992] for LE and AD, respectively. Positive and negative predictive values were 95.8% (95%CI:76.5%-99.4%) and 94.9% (95%CI:89.4%-97.6%) for LE and 89.0% (95%CI:72.2%-96.1%) and 96.0% (95%CI:90.5%-98.3%) for AD. While both tests were useful in 18 cases that were inconclusive based on preoperative findings, AD had no benefit over LE.

Conclusion: Both LE and AD are valuable markers in patients with suspected PJI. Since LE is very inexpensive and readily available point-of-care test, we believe it offers more value in the work up of suspected PJI.

摘要

背景：白细胞酯酶 (LE) 和 α-防御素 (AD) 是用于诊断假体周围感染 (PJI) 的两种滑膜生物标志物，然而，一种优于另一种的优越性仍然未知。我们旨在比较它们的诊断价值。

方法：在这项回顾性研究中，我们评估了 2013 年至 2019 年间在单一机构接受翻修全髋关节和膝关节置换术的患者，这些患者可同时使用 LE 和 AD。PJI 由 2018 年国际共识会议标准定义。比较AD和LE的诊断性能。

结果：总共纳入了 122 名患者（28 名 PJI 和 94 名无菌翻修）。LE 和 AD 的曲线下面积分别为 0.905（95% 置信区间 [CI]:0.820–0.991）和 0.913 [95%CI:0.834–0.992]。LE 的阳性和阴性预测值分别为 95.8% (95%CI:76.5%-99.4%) 和 94.9% (95%CI:89.4%-97.6%) 和 89.0% (95%CI:72.2%-96.1%) 和AD 为 96.0% (95%CI:90.5%-98.3%)。虽然这两种测试在 18 例基于术前发现尚无定论的病例中都有用，但 AD 与 LE 相比没有任何益处。

结论: LE 和 AD 都是疑似 PJI 患者的有价值的标志物。由于 LE 是一种非常便宜且易于获得的即时检验，我们相信它在疑似 PJI 的工作中提供了更多价值。