Comparative Analysis Of Procalcitionin To Diagnosis Infection In Revision Hip And Knee Arthroplasties

Objectives:Apprising procalcitionin’s role for detecting infection after joint replacement.Methods:A retrospective study is used in this paper.Target and group:Between January 2010 and December 2015,We study the patients who expericed the joint revision operation including THA or TKA in the Second Hospital of Shanxi Medical University.48 patients were included,and 19 patients were joint infection,29 patients were aseptic failure. Standard culture was negative in 15 patients of 19 patients,while the long-term culture was positive.There was only one patient with a fistula.3 patients was positive both in standard culture and long-term culture.So these 19 patients were included in the inflectional revision group.The total 29 patients’ culture result was negative both in standard culture and long-term culture.There are 9 female patients and 10 male patients,the age varies from 57-75,the average age is 63.79.While in the 29 patients,There are 17 female patients and 12 male patients,the age varies from47-85,the average age is 68.27.The source of date:collect the patients’ sexuality,age,location of revision operation,body mass index,and preoperational date:C-protein, ESR, procalcitionin.Results:1、The comparation of location,age,body mass index,sexuality of revision operation form group A and group,P>0.05,there is no statistically significant difference.2、The results of three biomarker:(1)For procalcitionin,P < 0.001,the difference was statistically significant between group A and group B.For C-protein,p<0.001,the difference was statistically significantbetween group A and group B.For ESR,p<0.001,the difference was statistically significantbetween group A and group B.(2)According to the diagnosing standard,the septic and aseptic patients were distinguished. The Receiver Operating Characteristic(ROC) curve reveals that the hightest area under the curive is 0.905(95% CI,0.818,0.992)observed for C-protein.The area under the curive was 0.749(95% CI, 0.593,0.904) for procalcitionin. The area under the curive was 0.805(95% CI,0.684,0.926) for ESR.With combining different parameter,the minimal distance witn the point in ROC was regarded the optimal threshold. For procalcitionin,C-protein and ESR,the optimal thresholds were 0.81ng/ml,14.25 mg/ml and 28.7 mm/h.The sensitivity and specificity of C-protein was94.7%,86.2%.For ESR,The sensitivity and specificity was 73.7%,69.0%,theprocalcitionin was 42%,93.1%.Conclusions:The sensitiveity of C-protein was the biggest,the specificity was smaller than Procalcitionin but higher than ESR.Although the C-protein can not recognize all the patients with infection,it is a most useful biomarker.The sensitivity and specificity of ESR was lower,but it is a helpful biomarker for detecting infection.The sensitivity of procalcitionin was the lowest,but the specificity is the biggest,so we can believe that the procalcitionin can rule out false positive cases that were detected by elevated ESR and C-protein. We should think about the biomarker(such as ESR,C-protein,procalcitionin),the symptom of the patients,histological evidence and the result of culture,when we diagnosis the infection.