| Objective:By detecting the preoperative serum WBC,CRP,ESR,D-dimer and calculating Neutrophil count to lymphocyte count ratio(NLR),Platelet count to lymphocyte count ratio(PLR),Systemic immune inflammatory index(SII)of patients with joint revision,and to explore the diagnostic value and significance in periprosthetic infection.Methods:A retrospective analysis of January 2013 to December 2020 in the Guangxi Zhuang Autonomous Region People’s Hospital of patients with joint prosthesis revision of 76 cases,according to the MSIS standard,it is divided into33 cases in the infected group and 43 cases in the non-infected group.By collecting preoperative serum WBC,CRP,ESR,D-dimer,calculated NLR,PLR,SII value,using ROC to analyze the sensitivity and specificity of WBC,CRP,ESR,D-dimer,NLR,PLR,and SII in the blood of each group of patients,and calculate the Youden index and the area under the ROC curve(AUC).Analyze the value and significance of various indicators in the diagnosis of periprosthetic infections after joint replacement.Draw the combined ROC curve and calculate the AUC for meaningful indicators to evaluate the combined diagnosis effect.Results: 1.There were no statistically significant(p> 0.05)differences in gender(P=0.622),age(P=0.196),BMI(P=0.980),and surgical site(P=0.961).2.The median differences of WBC in the infected and non-infected groups were 7.07 10^9/L,6.53(10^9/L)(Z=0.749 P=0.454),the difference was not statistically significant(p>0.05).The median differences of NLR in the infected and non-infected groups were 2.61,1.98(Z=0.833 P=0.405),the difference was not statistically significant(p > 0.05).The median differences of PLR in the infected and non-infected groups were 148.20,140.79(Z=0.791 P=0.429),the difference was not statistically significant(p>0.05).The median differences of SII in the infected and non-infected groups were 634.41,521.85(Z=1.273P=0.203),the difference was not statistically significant(p>0.05).3.The median differences of CRP in the infected and non-infected groups were 20.64mg/L,5.81mg/L(Z= 5.161 P=0.000),the difference was statistically significant(p < 0.05).The median differences of ESR in the infected and non-infected groups were 68.00mm/h,33.33mm/h(Z=3.884 P=0.000),the difference was statistically significant(p < 0.05).The median differences of D-dimer in the infected and non-infected groups were 2.46mg/L,0.82mg/L(Z=5.099 P=0000),the difference was statistically significant(p<0.05).4.The sensitivity and specificity of CRP at the threshold of 12.245mg/L were 90.9% and 76.7%,respectively,and the AUC was0.840,(95%CI=[0.748-0.932],p=0.000),the difference was statistically significant significance(p<0.05).The sensitivity and specificity of ESR at the threshold of 45mm/h were 81.8% and 65.1%,respectively,and the AUC was0.761,(95%CI=[0.653-0.869],p=0.000),the difference was statistically significant significance(p<0.05).The sensitivity and specificity of D-dimer at the threshold of 1.78mg/L were 69.7% and 88.4%,respectively,and the AUC was 0.843,(95%CI=[0.755-0.931],p=0.000),the difference was statistically significant significance(p<0.05).5.The common AUC of CRP,ESR,and D-dimer is greater than any of them,the sensitivity and specificity are 75.8% and 95.3%,respectively.The combined AUC of the three is 0.928,(95%CI=[0.873-0.983 ],p=0.000),the difference is statistically significant(p<0.05).Outstanding performance in terms of specificity.Conclusion:1.In terms of diagnosing PJI,the values of WBC,NLR,PLR,and SII were not statistically different between the infected group and the non-infected group,and did not show much clinical diagnostic value.2.In the diagnosis of PJI,CRP,ESR,and D-dimer all show high clinical diagnostic value,and there are significant differences between the infected group and the non-infected group,and the difference is statistically significant.CRP(90.9%)has the highest sensitivity in the diagnosis of PJI,followed by ESR(81.8%)and D-dimer(69.7%).D-dimer(88.4%)has the greatest specificity in the diagnosis of PJI,followed by CRP(76.6%)and ESR(65.1%).The three have high value for the diagnosis of PJI,but the single one lacks high specificity in the diagnosis of PJI.3.CRP(0.840)and D-dimer(0.843)AUC are basically equal,and their value in diagnosing PJI is basically the same.D-dimer and CRP both the AUC greater than ESR(0.761),in terms of diagnostic value higher than ESR.4.The combined detection of CRP,ESR,and D-dimer is significantly more valuable in the diagnosis of PJI than the three independent tests.Before arthroplasty combined detection for the diagnosis of PJI is recommended,and higher specificity... |
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