Abstract：
OBJECTIVE: This study aimed to explore the diagnostic value of synovial fluid neutrophil extracellular traps (SF-NETs) in periprosthetic joint infection (PJI) diagnosis, and compare it with that of microbial culture, serum ESR and CRP, synovial white blood cell (WBC) count, and polymorphonuclear neutrophil percentage (PMN%).
METHODS: In a single health centre, patients with suspected PJI were enrolled from January 2013 to December 2021. The inclusion criteria were: 1) patients who were suspected to have PJI; 2) patients with complete medical records; and 3) patients from whom sufficient synovial fluid was obtained for microbial culture and NET test. Patients who received revision surgeries due to aseptic failure (AF) were selected as controls. Synovial fluid was collected for microbial culture and SF-WBC, SF-PNM%, and SF-NET detection. The receiver operating characteristic curve (ROC) of synovial NET, WBC, PMN%, and area under the curve (AUC) were obtained; the diagnostic efficacies of these diagnostic indexes were calculated and compared.
RESULTS: The levels of SF-NETs in the PJI group were significantly higher than those of the AF group. The AUC of SF-NET was 0.971 (95% confidence interval (CI) 0.903 to 0.996), the sensitivity was 93.48% (95% CI 82.10% to 98.63%), the specificity was 96.43% (95% CI 81.65% to 99.91%), the accuracy was 94.60% (95% CI 86.73% to 98.50%), the positive predictive value was 97.73%, and the negative predictive value was 90%. Further analysis showed that SF-NET could improve the diagnosis of culture-negative PJI, patients with PJI who received antibiotic treatment preoperatively, and fungal PJI.
CONCLUSIONS: SF-NET is a novel and ideal synovial fluid biomarker for PJI diagnosis, which could improve PJI diagnosis greatly.Cite this article: Bone Joint Res 2023;12(2):113-120.
METHODS: In a single health centre, patients with suspected PJI were enrolled from January 2013 to December 2021. The inclusion criteria were: 1) patients who were suspected to have PJI; 2) patients with complete medical records; and 3) patients from whom sufficient synovial fluid was obtained for microbial culture and NET test. Patients who received revision surgeries due to aseptic failure (AF) were selected as controls. Synovial fluid was collected for microbial culture and SF-WBC, SF-PNM%, and SF-NET detection. The receiver operating characteristic curve (ROC) of synovial NET, WBC, PMN%, and area under the curve (AUC) were obtained; the diagnostic efficacies of these diagnostic indexes were calculated and compared.
RESULTS: The levels of SF-NETs in the PJI group were significantly higher than those of the AF group. The AUC of SF-NET was 0.971 (95% confidence interval (CI) 0.903 to 0.996), the sensitivity was 93.48% (95% CI 82.10% to 98.63%), the specificity was 96.43% (95% CI 81.65% to 99.91%), the accuracy was 94.60% (95% CI 86.73% to 98.50%), the positive predictive value was 97.73%, and the negative predictive value was 90%. Further analysis showed that SF-NET could improve the diagnosis of culture-negative PJI, patients with PJI who received antibiotic treatment preoperatively, and fungal PJI.
CONCLUSIONS: SF-NET is a novel and ideal synovial fluid biomarker for PJI diagnosis, which could improve PJI diagnosis greatly.Cite this article: Bone Joint Res 2023;12(2):113-120.
摘要：
目的：本研究旨在探讨滑液中性粒细胞胞外诱捕网（SF-NETs）在假体周围感染（PJI）诊断中的诊断价值。并将其与微生物培养进行比较，血清ESR和CRP，滑膜白细胞（WBC）计数，和多形核中性粒细胞百分比(PMN%)。
方法：在一个医疗中心，2013年1月至2021年12月纳入疑似PJI患者.纳入标准为：1）怀疑患有PJI的患者；2）具有完整病历的患者；3）从中获得足够的滑液进行微生物培养和NET测试的患者。选择由于无菌失效(AF)而接受翻修手术的患者作为对照。收集滑液进行微生物培养和SF-WBC,SF-PNM%，和SF-NET检测。滑膜NET的受体工作特性曲线（ROC），WBC,PMN%,获得曲线下面积（AUC）；计算并比较这些诊断指标的诊断效果。
结果：PJI组的SF-NETs水平明显高于AF组。SF-NET的AUC为0.971（95％置信区间（CI）0.903至0.996），敏感性为93.48%（95%CI为82.10%至98.63%），特异性为96.43%（95%CI81.65%至99.91%），准确率为94.60%(95%CI为86.73%至98.50%)，阳性预测值为97.73%,阴性预测值为90%。进一步分析表明SF-NET可以提高培养阴性PJI的诊断，术前接受抗生素治疗的PJI患者，和真菌PJI。
结论：SF-NET是PJI诊断的新型理想滑液生物标志物，这可以大大提高PJI的诊断。引用这篇文章：骨关节Res2023；12（2）：113-120。
方法：在一个医疗中心，2013年1月至2021年12月纳入疑似PJI患者.纳入标准为：1）怀疑患有PJI的患者；2）具有完整病历的患者；3）从中获得足够的滑液进行微生物培养和NET测试的患者。选择由于无菌失效(AF)而接受翻修手术的患者作为对照。收集滑液进行微生物培养和SF-WBC,SF-PNM%，和SF-NET检测。滑膜NET的受体工作特性曲线（ROC），WBC,PMN%,获得曲线下面积（AUC）；计算并比较这些诊断指标的诊断效果。
结果：PJI组的SF-NETs水平明显高于AF组。SF-NET的AUC为0.971（95％置信区间（CI）0.903至0.996），敏感性为93.48%（95%CI为82.10%至98.63%），特异性为96.43%（95%CI81.65%至99.91%），准确率为94.60%(95%CI为86.73%至98.50%)，阳性预测值为97.73%,阴性预测值为90%。进一步分析表明SF-NET可以提高培养阴性PJI的诊断，术前接受抗生素治疗的PJI患者，和真菌PJI。
结论：SF-NET是PJI诊断的新型理想滑液生物标志物，这可以大大提高PJI的诊断。引用这篇文章：骨关节Res2023；12（2）：113-120。
