Can Platelets/Mean Platelet Volume Accurately Diagnose Periprosthetic Joint Infection? Revealing Their Actual Diagnostic Efficacy

Abstract

Background

Currently, there is no single test indicator for diagnosing periprosthetic joint infection (PJI) with an acceptable level of sensitivity. Therefore, ratio indicators have been introduced to improve the accuracy of diagnostic algorithms. Platelet count /mean platelet volume (PMR) is reported to be a potential PJI diagnostic biomarker, but its clinical value for diagnosing PJI is still uncertain. This study aims to provide additional evidence to support the effectiveness of PMR in accurately diagnosing PJI.

Methods

This study recruited 116 patients with PJI and 137 patients with aseptic loosening, divided them into PJI group and AL group. Collect subjects’ preoperative laboratory indicators such as ESR, CRP, PLT, MPV, etc. The area under the curve (AUC) was calculated by plotting the receiver operating characteristic (ROC) curve to determine the diagnostic efficacy of PMR.

Results

ESR, CRP, PLT, and PLT/MPV were significantly increased in the PJI group, while MPV levels were decreased (both P< 0.001). The AUC of the PMR was 0.752, and the optimal cut-off value for diagnosing chronic PJI was determined to be 27.8 based on the Youden index. The sensitivity and specificity for diagnosing PJI were 79.3% and 47.9%, respectively, with a positive predictive value of 68.27%, a negative predictive value of 69.80%, and a diagnostic odds ratio of 4.97. The AUC (0.752) of the ratio biomarker was lower than that of ESR (0.825) and CRP (0.900). After predictive model calculation, the combination of PMR, CRP, and ESR had an AUC value of 0.910, with a sensitivity of 84.5% and a specificity of 84.7%, showing good discriminative ability.

Conclusion

Compared with traditional biomarkers ESR and CRP, the value of the PMR for diagnosing PJI is not significant, but it can be used as an auxiliary indicator for PJI diagnosis in combination with other indicators (P<0.001).

Keywords:

• periprosthetic joint infection
• biomarkers
• C-reactive protein
• erythrocyte sedimentation rate
• platelet count/mean platelet volume
• diagnosis

Abbreviations

CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; WBC, white blood cell; LE, leukocyte; PMN (%); Polymorphonuclear Neutrophils (%); BMI, Body Mass Index; PLT, blood platelet; MPV, Mean Platelet Volume; PMR, Platelet count /mean platelet volume; AUC, area under the curve; PPV, Positive Predictive Value; NPV, Negative Predictive Value; DOR, diagnostic odds ratio; PLR, Positive likelihood ratio; NLR, Negative likelihood ratio; MLR, monocyte/lymphocyte ratio.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

This study conformed to the guidelines of the Helsinki Declaration. Ethics approval was obtained by the Research Ethics Committee of the Institutional Review Committee of Jining Medical College Affiliated Hospital.

Acknowledgments

We acknowledge that all the participants participated in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

There is no funding to report.