C-reactive protein/albumin and C-reactive protein/fibrinogen ratios for the diagnosis of periprosthetic joint infection in revision total joint arthroplasty

Yuangang Wu; Kaibo Sun; Ran Liu; Liming Wu; Yi Zeng; Mingyang Li; Jiawen Xu; Bin Shen

doi:10.1016/j.intimp.2023.109682

C-reactive protein/albumin and C-reactive protein/fibrinogen ratios for the diagnosis of periprosthetic joint infection in revision total joint arthroplasty

Int Immunopharmacol. 2023 Feb:115:109682. doi: 10.1016/j.intimp.2023.109682. Epub 2023 Jan 7.

Authors

Yuangang Wu¹, Kaibo Sun¹, Ran Liu², Liming Wu¹, Yi Zeng¹, Mingyang Li¹, Jiawen Xu¹, Bin Shen³

Affiliations

¹ Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China.
² Engineering Research Center of Medical Information Technology, Ministry of Education, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
³ Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China. Electronic address: shenbin_1971@163.com.

PMID: 36623413
DOI: 10.1016/j.intimp.2023.109682

Abstract

Aim: Testing for systemic inflammation markers is considered a simpler method for diagnosing periprosthetic joint infection (PJI). Changes in the C-reactive protein/albumin ratio (CRP/Alb ratio) and C-reactive protein/fibrinogen ratio (CRP/Fib ratio) are associated with PJI. This study aimed to evaluate the application of CRP/Alb and CRP/Fib ratios as novel inflammation-based markers for the diagnosis of PJI.

Methods: We retrospectively evaluated 445 patients who underwent total hip and knee revision arthroplasties between January 2010 and February 2021. Of these, 129 patients were also independently evaluated for PJI with coagulation-related comorbidities. The patients were divided into two groups: the aseptic revision (268 patients) and PJI revision groups (187 patients). Subsequently, we evaluated the diagnostic value of the CRP/Alb and CRP/Fib ratios compared to other inflammation-based diagnoses using the area under the curve (AUC) values.

Results: The AUC values of the CRP/Alb and CRP/Fib ratios were 0.880 and 0.872, respectively, suggesting similar diagnostic potentials for PJI. The CRP/Alb and CRP/Fib ratios were better than the erythrocyte sedimentation rate (ESR), Alb, and Fib, whose AUC values were 0.765, 0.352, and 0.730, respectively, for the diagnosis of PJI. The optimal cut-off for the CRP/Alb ratio was 0.13, with good sensitivity (85.0%) and specificity (78.4%). The optimal cut-off CRP/Fib ratio was 2.04, with good sensitivity (81.3%) and specificity (80.6%). Notably, the CRP/Alb and CRP/Fib ratios had the highest sensitivity, followed by four conventional inflammatory markers, namely, CRP, ESR, Alb, and Fib, which had sensitivities of 80.2%, 67.4%, 50.8%, and 54.0%, respectively. Similar findings were observed in patients with coagulation-related comorbidities.

Conclusion: Both the CRP/Alb and CRP/Fib ratios were significantly higher in patients with PJI than in those with aseptic failure and showed better sensitivity and specificity for diagnosing PJI than classical inflammatory markers.

Keywords: AUC; CRP/Alb ratio; CRP/Fib ratio; Diagnosis; PJI.

MeSH terms

Arthritis, Infectious*
Arthroplasty, Replacement, Hip* / adverse effects
Biomarkers
Blood Sedimentation
C-Reactive Protein / analysis
Fibrinogen
Humans
Inflammation
Prosthesis-Related Infections* / diagnosis
Prosthesis-Related Infections* / surgery
Retrospective Studies
Sensitivity and Specificity
Serum Albumin, Human / analysis

Substances

Biomarkers
C-Reactive Protein
Fibrinogen
Serum Albumin, Human