Clinical Value Of Synovial Fluid Heparin-binding Protein In The Diagnosis Of Chronic Periprosthetic Joint Infection

Objective: Periprosthetic joint infection is a catastrophic compliment of artificial joint replacement,which will impose a heavy burden on patients physically,mentally and economically.A correct early diagnosis of PJI is of great significance to its coming treatment and prognosis.However,there is no consensus on the gold standard in diagnosing PJI,which is still a difficult problem in oethopedics.The purpose of this study is to explore the diagnostic value of HBP for chronic PJI,and compare it with common infection associated serological indicators(C-reactive protein,ESR,procalcitonin,leukocyte number,neutrophil percentage)and joint fluid examinations(joint fluid culture,joint fluid smear microscopy),to improve the accuracy of differential diagnosis of chronic PJI.Method:Between January 2019 and January 2020,78 adult patients with suspected chronic PJI from the third hospital of Hebei medical university were selected and their joint fluid samples,venous blood samples and medical records were collected.According to the experimental design and kits requirements,42 cases were selected into the final statistical analysis.According to the recent international consensus on PJI diagnosis to create two groups of patients,septic(18 cases)and aseptic(24 cases).Comparing the differences of every indicators between the two groups and creating their ROC curve to determine the cutoff values and diagnostic accuracy for each indicator.Multiple combinations were created by using selected cutoff values and were compared to evaluate their diagnostic accuracy.Result:Compared with the aseptic cases,there is a significant increase in the C-reactive protein,ESR,HBP and the synovial fluid leucocyte in the septic cases,but there is no statistic differences in procalcitonin,WBC and neutrophil percentage.The sensitivity and specificity of synovial fluid culture are 88.9% and 100%.The optimal cut-off value of C-reaction protein is 11mg/L(AUC 0.8785,sensitivity 100%,specificity 66.7%,PV+69.2%,PV-100%,LR+3.0,LR-0).The optimal cut-off value of ESR is 41.5mm/h(AUC 0.8831,sensitivity 72.22%,specificity 91.67%,PV+86.7%,PV-81.5%,LR+8.7,LR-0.3).The optimal cut-off value of fluid leukocyte is ++(2?5 white blood cells/ oil mirror vision,AUC 0.8565,sensitivity 66.67%,specificity 95.83%,PV+92.3%,PV-79.3%,LR+15.6,LR-0.3).The optimal cut-off value of HBP is 290ng/m L(AUC 0.7581,sensitivity 72.2%,specificity 70.8%,PV+61.9%,PV-76.2%,LR+2.5,LR-2.6).Combined detection of CRP,ESR and HBP.The parallel sensitivity and specticity of CRP and ESR are 100% and 62.5%.The specificity and the sensitivity of ESR in series with HBP are 100% and 61.1%.Conclusion:CRP has a high sensitivity and ESR,synovial fluid WBC have a high specificity,but they cannot be used alone to diagnose chronic PJI.Continuous joint fluid culture is still an important basis for the diagnosis of chronic PJI.HBP,as a new diagnostic index,has medium value for chronic PJI.Combined detection can increase the diagnositic efficiency.