Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection
Aims: Synovial fluid white blood cell (WBC) count and percentage of polymorphonuclear cells (%PMN) are elevated at periprosthetic joint infection (PJI). Leucocytes produce different interleukins (IL), including IL-6, so we hypothesized that synovial fluid IL-6 could be a more accurate predictor of P...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2020-12-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.112.BJO-2020-0166.R1 |
| _version_ | 1818838896252813312 |
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| author | René Mihalič Jurij Zdovc Peter Brumat Rihard Trebše |
| author_facet | René Mihalič Jurij Zdovc Peter Brumat Rihard Trebše |
| author_sort | René Mihalič |
| collection | DOAJ |
| description | Aims: Synovial fluid white blood cell (WBC) count and percentage of polymorphonuclear cells (%PMN) are elevated at periprosthetic joint infection (PJI). Leucocytes produce different interleukins (IL), including IL-6, so we hypothesized that synovial fluid IL-6 could be a more accurate predictor of PJI than synovial fluid WBC count and %PMN. The main aim of our study was to compare the predictive performance of all three diagnostic tests in the detection of PJI. Methods: Patients undergoing total hip or knee revision surgery were included. In the perioperative assessment phase, synovial fluid WBC count, %PMN, and IL-6 concentration were measured. Patients were labeled as positive or negative according to the predefined cut-off values for IL-6 and WBC count with %PMN. Intraoperative samples for microbiological and histopathological analysis were obtained. PJI was defined as the presence of sinus tract, inflammation in histopathological samples, and growth of the same microorganism in a minimum of two or more samples out of at least four taken. Results: In total, 49 joints in 48 patients (mean age 68 years (SD 10; 26 females (54%), 25 knees (51%)) were included. Of these 11 joints (22%) were infected. The synovial fluid WBC count and %PMN predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 82%, 97%, 94%, 90%, and 95%, respectively. Synovial fluid IL-6 predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 73%, 95%, 90%, 80%, and 92%, respectively. A comparison of predictive performance indicated a strong agreement between tests. Conclusions: Synovial fluid IL-6 is not superior to synovial fluid WBC count and %PMN in detecting PJI. Level of Evidence: Therapeutic Level II |
| first_indexed | 2024-12-19T03:45:41Z |
| format | Article |
| id | doaj.art-0123addfbe36408bad3c783c35733971 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-19T03:45:41Z |
| publishDate | 2020-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-0123addfbe36408bad3c783c357339712022-12-21T20:37:07ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622020-12-0111273774210.1302/2633-1462.112.BJO-2020-0166.R1Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infectionRené Mihalič0Jurij Zdovc1Peter Brumat2Rihard Trebše3Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, SloveniaFaculty of Pharmacy, University of Ljubljana, Ljubljana, SloveniaService for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, SloveniaService for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, SloveniaAims: Synovial fluid white blood cell (WBC) count and percentage of polymorphonuclear cells (%PMN) are elevated at periprosthetic joint infection (PJI). Leucocytes produce different interleukins (IL), including IL-6, so we hypothesized that synovial fluid IL-6 could be a more accurate predictor of PJI than synovial fluid WBC count and %PMN. The main aim of our study was to compare the predictive performance of all three diagnostic tests in the detection of PJI. Methods: Patients undergoing total hip or knee revision surgery were included. In the perioperative assessment phase, synovial fluid WBC count, %PMN, and IL-6 concentration were measured. Patients were labeled as positive or negative according to the predefined cut-off values for IL-6 and WBC count with %PMN. Intraoperative samples for microbiological and histopathological analysis were obtained. PJI was defined as the presence of sinus tract, inflammation in histopathological samples, and growth of the same microorganism in a minimum of two or more samples out of at least four taken. Results: In total, 49 joints in 48 patients (mean age 68 years (SD 10; 26 females (54%), 25 knees (51%)) were included. Of these 11 joints (22%) were infected. The synovial fluid WBC count and %PMN predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 82%, 97%, 94%, 90%, and 95%, respectively. Synovial fluid IL-6 predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 73%, 95%, 90%, 80%, and 92%, respectively. A comparison of predictive performance indicated a strong agreement between tests. Conclusions: Synovial fluid IL-6 is not superior to synovial fluid WBC count and %PMN in detecting PJI. Level of Evidence: Therapeutic Level IIhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.112.BJO-2020-0166.R1synovial fluidinterleukin-6il-6periprosthetic joint infectionpji |
| spellingShingle | René Mihalič Jurij Zdovc Peter Brumat Rihard Trebše Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection Bone & Joint Open synovial fluid interleukin-6 il-6 periprosthetic joint infection pji |
| title | Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection |
| title_full | Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection |
| title_fullStr | Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection |
| title_full_unstemmed | Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection |
| title_short | Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection |
| title_sort | synovial fluid interleukin 6 is not superior to cell count and differential in the detection of periprosthetic joint infection |
| topic | synovial fluid interleukin-6 il-6 periprosthetic joint infection pji |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.112.BJO-2020-0166.R1 |
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