Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections
<p><strong>Introduction</strong>: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio b...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Copernicus Publications
2021-06-01
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| Series: | Journal of Bone and Joint Infection |
| Online Access: | https://jbji.copernicus.org/articles/6/229/2021/jbji-6-229-2021.pdf |
| Summary: | <p><strong>Introduction</strong>: The gold standard for determining the duration of
periprosthetic joint infection (PJI) is a thorough history. Currently, there
are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP
(mg/L) in joint arthroplasty. This study suggests the ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M2" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="527256ea34e0af356380afd605ccefc0"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00003.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00003.png"/></svg:svg></span></span> CRP ratio will help differentiate acute from chronic PJI. <strong>Methods</strong>: Retrospective review of patients with PJI was performed. Inclusion
criteria: patients <span class="inline-formula">>18</span> years old who underwent surgical revision
for PJI and had documented ESR and CRP values. Subjects were divided into
two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the
ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M4" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="57ee8123d9c9aefcf23d9c7f6463c158"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00004.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00004.png"/></svg:svg></span></span> CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M5" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="93e47eb16cb371fe6916d3191efc4f1d"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00005.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00005.png"/></svg:svg></span></span> CRP ratio in
characterizing the duration of PJI.
<strong>Results</strong>: 147 patients were included in the study (81 acute and 66 chronic).
The mean ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M6" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="073414a2b77546d8d5847ae97897d626"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00006.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00006.png"/></svg:svg></span></span> CRP ratio in acute patients was 0.48 compared to 2.87 in
chronic patients (<span class="inline-formula"><i>p</i><0.001</span>). The ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M8" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="fb147fccdcf98a9911cf3d26a8f6dc33"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00007.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00007.png"/></svg:svg></span></span> CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for
ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M9" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="880d1b22cfae9b4167ff115d05c6894c"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00008.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00008.png"/></svg:svg></span></span> CRP to predict a chronic (<span class="inline-formula">>0.96</span>) vs. acute (<span class="inline-formula"><0.96</span>) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and
the specificity was 0.90 (95 % CI 0.81–0.94).
<strong>Conclusions</strong>: The ESR <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M12" display="inline" overflow="scroll" dspmath="mathml"><mo>/</mo></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="8pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="6bfc4ae3491d603d986b6e1d0e6866cf"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-6-229-2021-ie00009.svg" width="8pt" height="14pt" src="jbji-6-229-2021-ie00009.png"/></svg:svg></span></span> CRP ratio may help determine the duration of PJI in
uncertain cases. This metric may give arthroplasty surgeons more confidence
in defining the duration of the PJI and therefore aid in treatment
selection.</p> |
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| ISSN: | 2206-3552 |