Abstract
BackgroundSynovial fluid α-defensin is a valuable biomarker for periprosthetic joint infection (PJI). Its diagnostic value for PJI has been widely evaluated recently, but results are inconsistent, especially for different test methods. The objective of this study was to evaluate the diagnostic value of laboratory-based immunoassay and lateral flow testing for the detection of α-defensin against hip and knee PJI.MethodsWe systematically searched MEDLINE and EMBASE for articles on the diagnostic accuracy of α-defensin for PJI published up to September 2018. The pooled sensitivity, specificity, area under the curve (AUC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated for the evaluation of the diagnostic value of α-defensin for PJI.ResultsNineteen studies were included. Eleven evaluated laboratory-based immunoassay, and 10 evaluated the lateral flow test results. The pooled sensitivity, specificity, AUC, PLR, NLR, and DOR of laboratory-based immunoassays were 0.96 (95% confidence interval [CI] 0.90–0.98), 0.97 (95% CI 0.95–0.99), 0.99 (95% CI 0.98–1.00), 35.0 (95% CI 18.5–66.2), 0.04 (95% CI 0.02–0.11), and 811 (95% CI 220–2990), respectively. The pooled sensitivity, specificity, AUC, PLR, NLR, and DOR of the lateral flow test were 0.86 (95% CI 0.81–0.91), 0.96 (95% CI 0.93–0.98), 0.95 (95% CI 0.93–0.97), 21.2 (95% CI 11.7–38.5), 0.14 (95% CI 0.10–0.21), and 148 (95% CI 64–343), respectively.ConclusionsLaboratory-based immunoassay of α-defensin is highly accurate for the diagnosis of hip and knee PJI. The lateral flow test is less sensitive but still a useful intraoperative detection tool for PJI.
Highlights
Synovial fluid α-defensin is a valuable biomarker for periprosthetic joint infection (PJI)
One genomic study showed that the expression and release of α-defensin is a specific response of neutrophils to infectious arthritis that is not affected by non-infectious inflammation, such as acute gouty arthritis [32]
Eligibility criteria Studies included in our meta-analysis complied with the following criteria: (1) studies that evaluated the accuracy of α-defensin for the diagnosis of PJI with the original or updated Musculoskeletal Infection Society (MSIS) criteria
Summary
Synovial fluid α-defensin is a valuable biomarker for periprosthetic joint infection (PJI). The objective of this study was to evaluate the diagnostic value of laboratory-based immunoassay and lateral flow testing for the detection of α-defensin against hip and knee PJI. One genomic study showed that the expression and release of α-defensin is a specific response of neutrophils to infectious arthritis that is not affected by non-infectious inflammation, such as acute gouty arthritis [32] This suggests that α-defensin has the potential to be an accurate indicator in the diagnosis of PJI. Synovial fluid α-defensin can be detected by both laboratorybased immunoassay and a lateral flow test. In the former, synovial fluid is sent to an advanced laboratory within 24 h and measured via standard enzyme-linked immunosorbent assay (ELISA). The lateral flow test is a rapid detection device that can be used for intraoperative PJI diagnosis
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