Serum interleukin 6 could be a valuable initial diagnostic tool in prosthetic knee joint infections.
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee
/ adverse effects
Biomarkers
/ blood
Blood Sedimentation
C-Reactive Protein
/ metabolism
Female
Humans
Interleukin-6
/ blood
Knee Prosthesis
/ adverse effects
Leukocyte Count
Male
Middle Aged
Neutrophils
Predictive Value of Tests
Preoperative Period
Prospective Studies
Prosthesis-Related Infections
/ blood
ROC Curve
Synovial Fluid
/ cytology
Interleukin 6
Prosthetic joint infection
Total knee arthroplasty
Journal
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
ISSN: 1432-1068
Titre abrégé: Eur J Orthop Surg Traumatol
Pays: France
ID NLM: 9518037
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
30
04
2019
accepted:
22
07
2019
pubmed:
28
7
2019
medline:
22
4
2020
entrez:
28
7
2019
Statut:
ppublish
Résumé
Accurate preoperative diagnosis of prosthetic joint infection (PJI) in the absence of obvious clinical signs or laboratory findings is challenging. Interleukin 6 (IL-6) has been proposed as an infection marker but supportive data are limited. We studied the diagnostic utility of serum IL-6 in infected total knee arthroplasty (TKA). A prospective cohort study was done in 52 patients (59 knees) with a painful TKA. The abnormal limits for serum IL-6, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), synovial fluid white cell counts (WBC) and synovial fluid neutrophils (PMN) were determined from receiver operating characteristic curves. An infection was defined as the presence of sinus tract or positive culture > two separate tissue or fluid samples. We utilized Mann-Whitney test, Spearman's correlation and Fischer's exact test to determine the sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy of serum IL-6. The optimal threshold concentration of serum IL-6 was 9.14 pg/ml. Independently, this yielded a sensitivity, specificity and NPV of 81%, 63% and 85%, respectively, and when combined with synovial fluid WBC, values were 100%, 90%, 100%, respectively. The sensitivity and specificity of ESR (70%, 63.6%), CRP (66.7%, 66.7%), synovial WBC (66.7%, 81%) and synovial PMN (82.4%, 73.7%) were also calculated. Serum IL-6 levels strongly correlate with all markers in PJI. Serum IL-6 improves the diagnosis of PJI over existing methods, especially when combined with synovial fluid WBC. Its optimal usage is as an excellent screening test to rule out infected total knee arthroplasty. Diagnostic Level II.
Sections du résumé
BACKGROUND
BACKGROUND
Accurate preoperative diagnosis of prosthetic joint infection (PJI) in the absence of obvious clinical signs or laboratory findings is challenging. Interleukin 6 (IL-6) has been proposed as an infection marker but supportive data are limited. We studied the diagnostic utility of serum IL-6 in infected total knee arthroplasty (TKA).
METHODS
METHODS
A prospective cohort study was done in 52 patients (59 knees) with a painful TKA. The abnormal limits for serum IL-6, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), synovial fluid white cell counts (WBC) and synovial fluid neutrophils (PMN) were determined from receiver operating characteristic curves. An infection was defined as the presence of sinus tract or positive culture > two separate tissue or fluid samples. We utilized Mann-Whitney test, Spearman's correlation and Fischer's exact test to determine the sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy of serum IL-6.
RESULTS
RESULTS
The optimal threshold concentration of serum IL-6 was 9.14 pg/ml. Independently, this yielded a sensitivity, specificity and NPV of 81%, 63% and 85%, respectively, and when combined with synovial fluid WBC, values were 100%, 90%, 100%, respectively. The sensitivity and specificity of ESR (70%, 63.6%), CRP (66.7%, 66.7%), synovial WBC (66.7%, 81%) and synovial PMN (82.4%, 73.7%) were also calculated. Serum IL-6 levels strongly correlate with all markers in PJI.
CONCLUSIONS
CONCLUSIONS
Serum IL-6 improves the diagnosis of PJI over existing methods, especially when combined with synovial fluid WBC. Its optimal usage is as an excellent screening test to rule out infected total knee arthroplasty.
LEVEL OF EVIDENCE
METHODS
Diagnostic Level II.
Identifiants
pubmed: 31350652
doi: 10.1007/s00590-019-02519-y
pii: 10.1007/s00590-019-02519-y
doi:
Substances chimiques
Biomarkers
0
IL6 protein, human
0
Interleukin-6
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1781-1788Commentaires et corrections
Type : CommentIn
Références
J Arthroplasty. 2019 Feb;34(2S):S361-S367
pubmed: 30343972
J Arthroplasty. 2018 May;33(5):1309-1314.e2
pubmed: 29551303
FEMS Microbiol Lett. 2013 Jun;343(1):42-8
pubmed: 23480104
J Bone Joint Surg Am. 2010 Sep 1;92(11):2102-9
pubmed: 20810860
Cytokine. 1994 Mar;6(2):181-6
pubmed: 8032001
Int Orthop. 2012 Jan;36(1):65-71
pubmed: 21553042
J Immunol. 1990 Dec 15;145(12):4059-64
pubmed: 2258606
EFORT Open Rev. 2019 Jan 23;4(1):10-13
pubmed: 30800475
J Arthroplasty. 2016 Sep;31(9 Suppl):152-5
pubmed: 27094240
Int Orthop. 2000;24(4):194-6
pubmed: 11081839
J Arthroplasty. 2018 Aug;33(8):2571-2574
pubmed: 29656969
J Bone Joint Surg Am. 2005 Sep;87(9):1921-7
pubmed: 16140805
Am J Orthop (Belle Mead NJ). 2017 Jul/Aug;46(4):190-198
pubmed: 28856346
J Am Acad Orthop Surg. 2015 Apr;23 Suppl:S26-31
pubmed: 25808967
MBio. 2016 Jan 05;7(1):e01776-15
pubmed: 26733067
Clin Orthop Relat Res. 2013 Oct;471(10):3196-203
pubmed: 23568679
J Arthroplasty. 2011 Sep;26(6 Suppl):99-103.e1
pubmed: 21570803
Clin Orthop Relat Res. 2010 Dec;468(12):3263-7
pubmed: 20623261
J Bone Joint Surg Br. 2007 Jan;89(1):94-9
pubmed: 17259424
Clin Orthop Relat Res. 2001 Nov;(392):15-23
pubmed: 11716377
J Clin Microbiol. 1999 Oct;37(10):3281-90
pubmed: 10488193
Clin Orthop Relat Res. 2005 Nov;440:38-44
pubmed: 16239781