Erythrocyte Sedimentation Rate Sensitivity Research Articles

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

BackgroundBrucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients.MethodsA multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation.ResultsA total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5–58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906–8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176–2.384), arthralgia (OR = 3.197, 95% CI 1.986–5.148), eye bulging pain (OR = 3.482, 95% CI 1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310–2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145–2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%).ConclusionsMore than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

High Adenosine Deaminase Level and Erythrocyte Sedimentation Rate of Intestinal Tuberculosis Patients

BACKGROUND: Currently, laboratory diagnosis of intestinal tuberculosis (ITB) is limited based on clinical manifestations, providing opportunities for alternative laboratory tests to diagnose ITB. At the present time, the role of serum adenosine deaminase (ADA) and hematological tests in ITB patients are not widely known. The objective of this study was to determine the role of ADA and hematological tests in patients suspected with ITB.METHODS: Subjects that were suspected of ITB were classified as ITB group, while subjects with inflammatory bowel disease, hemorrhoid, and intestinal malignancy were classified as non-ITB group. Colonoscopy, histopathological examinations, and hematological test were performed. ADA measurement was also performed with clinical chemistry analyzer based on enzymatic colorimetry principle.RESULTS: Out of 143 subjects, 16 (11.2%) subjects were diagnosed with ITB and 127 (88.8%) subjects were classified as non-ITB group. ADA level and erythrocyte sedimentation rate (ESR) of ITB group were significantly higher than the ones of non-ITB group (p<0.05). Cut-off, sensitivity, and specificity of ADA level were 12.56 IU/L, 75%, and 57%, respectively. Cut-off, sensitivity, and specificity of ESR were 32.5 mm/hour, 81%, and 62%, respectively. Colonoscopy of ITB subjects displayed multiple ulcerations, edema, and hyperemic mucosa. Histopathological examination of ITB subjects exhibited granulomatous inflammation, epitheloid cells, giant cells, and lymphocyte aggregates.CONCLUSION: ADA level and ESR were significantly higher among ITB patients compared with non-ITB patients. Since the sensitivities of ADA and ESR tests were high, the ADA and ESR tests could be considered as a screening test for ITB.KEYWORDS: intestinal tuberculosis, adenosine deaminase, hematological tests

Role of C-Reactive Protein and Erythrocyte Sedimentation Rate in the Diagnosis and Monitoring of Treatment Response in Treatment Naïve Subjects with Chronic Pulmonary Aspergillosis.

The role of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for diagnosing chronic pulmonary aspergillosis (CPA) remains unknown. Herein, we investigate the diagnostic performance of serum ESR and CRP in CPA. We retrospectively analyzed the data of treatment-naïve subjects with CPA and diseased controls (post-tuberculosis lung disease on CT thorax). We treated CPA subjects with six months of oral itraconazole. Our primary objective was to evaluate the sensitivity and specificity of ESR and CRP in diagnosing CPA. The key secondary objective was to study the change in the inflammatory markers with treatment. We included 434 subjects and 20 diseased controls. The sensitivity and specificity of ESR (n = 434) and CRP (at cut-off value of 10mg/L, n = 308) in diagnosing CPA were 42.9% and 65%, and 52.3% and 65%, respectively. Both ESR and CRP had erratic trend following treatment. ESR and CRP declined or remained stable in approximately 60% of subjects but increased in approximately 40% of the subjects despite treatment. Serum CRP and ESR have limited utility in diagnosing and following subjects with CPA.

Evaluating the utility of inflammatory markers in the diagnosis of soft tissue abscesses of the forearm and hand.

Upper extremity abscesses frequently present to the acute care setting with inconclusive physical examination and imaging findings. We sought to investigate the diagnostic accuracy of inflammatory markers including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). A retrospective cohort study was performed to identify subjects years treated with surgical debridement of upper extremity abscesses at our institution between January2012 and December2015. In this study, 188 patients were screened, and 72 met the inclusion criteria. A confirmed abscess as defined by culture positivity was present in 67 (93.1 %) cases. The sensitivity of WBC, ESR, or CRP individually was 0.45, 0.71, and 0.81. The specificity of WBC, ESR, or CRP individually was 0.80, 0.80, and 0.40. In combination all three markers when positive had a sensitivity of 0.26 and specificity of 1.0. These values were similar among patients with diabetes and those with obesity. With the highest sensitivity and lowest specificity, CRP exhibited the most utility as a screening test (level IV).

Globulin and Albumin/Globulin Ratios as Potential Biomarkers for the Diagnosis of Acute and Chronic Peri-Prosthetic Joint Infections: A Retrospective Study.

Background: Peri-prosthetic joint infection (PJI) is the most serious complication after prosthetic joint replacement. However, the diagnosis of PJI remains challenging for clinicians because of the lack of a gold standard. The purpose of this study was to investigate the diagnostic significance of serum globulin, albumin/globulin, and other biomarkers in acute and chronic periprosthetic infections. Patients and Methods: A retrospective study of 162 patients with PJI and aseptic loosening between January 2016 and March 2021 at our institution was performed in three groups. There were 20 patients with acute infection in group A, 36 patients with chronic infection in group B, and 106 patients with aseptic loosening in group C. Globulin, albumin/globulin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet count (PLT), mean platelet volume (MPV), d-dimer, and platelet count/mean platelet volume ratio (PMR) levels were recorded. The area under the curve (AUC) was used to measure the diagnostic value of globulin and albumin/globulin with other biomarkers for PJI. Results: Compared with the aseptic loosening group, the acute and chronic PJI group had higher levels of CRP, ESR, d-dimer, globulin, PLT, and PMR (p < 0.01) and lower levels of albumin/globulin and MPV (p < 0.01). The optimal cutoff, AUC, sensitivity, and specificity of CRP, albumin/globulin, ESR, and globulin were: CRP, 8.3 mg/L, 0.903, 78.57%, and 88.68%; albumin/globulin, 1.31, 0.899, 91.07%, and 73.58%; ESR, 32 mm/h, 0.888, 75.%, and 85.85%; globulin, 29.5 g/L, 0.880, 91.07%, and 72.64%. Conclusions: Globulin and albumin/globulin have excellent diagnostic value for acute and chronic PJI and are promising potential biomarkers for the diagnosis of PJI. The diagnostic performance of albumin/globulin is superior to that of ESR and similar to that of CRP.

A New Inflammatory Marker of Clinical and Diagnostic Importance in Diabetic Foot Infection: Systemic Immune-Inflammation Index.

Diabetes and associated complications still pose an important public health problem. Osteomyelitis as especially seen in patients with diabetes is associated with increased rates of morbidity and mortality. The present study aimed to investigate the clinical and diagnostic significance of inflammatory markers, including the systemic immune-inflammation index (SII) and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT) to differentiate osteomyelitis and cellulitis. The present study included 96 patients with osteomyelitis (Group 1) and 151 patients with cellulitis (Group 2). Inflammatory markers were significantly elevated in Group 1 compared to Group 2 patients (p < 0.05). Furthermore, the correlation coefficients (rho) between SII and ESR, CRP, and PCT were 0.466 (p < 0.001), 0.627 (p < 0.001), and 0.501 (p < 0.001), respectively, as a result of Spearman's Rho analysis. Accordingly, a moderately positive relationship was found between the variables. The area under the curve (AUC) values for SII, ESR, CRP, and PCT in diabetic foot infection patients with osteomyelitis were 0.687, 0.722, 0.692, and 0.641, respectively. As a result of the Likelhood Ratio (LR) test, the cut-off values were 2.182 for SII (sensitivity: 39.8% and specificity: 79.8%), 76.5 mm/h for ESR (sensitivity: 59.1% and specificity: 73.1%), 109.5 mg/mL for CRP (sensitivity: 40.9% and specificity: 79.8%), and 0.44 ng/mL for PCT (sensitivity: 26.1% and specificity: 88.2%). In conclusion, given that the patients with osteomyelitis had much higher ESR, CRP, PCT, and SII levels combined with the fact that SII is a low-cost and easy-to-measure index, suggests that the same may serve as an effective and novel marker alternative to other inflammatory markers for predicting diabetic foot osteomyelitis.

Contribution of Erythrocyte Sedimentation Rate to Predict Disease Severity and Outcome in COVID-19 Patients.

Aim The use of erythrocyte sedimentation rate (ESR) in coronavirus disease 2019 (COVID-19) to determine disease severity and prognosis is limited. This study aimed to interrogate the diagnostic and prognostic role of ESR compared to other acute-phase reactants. Method This retrospective cross-sectional study included 493 confirmed and hospitalized adult COVID-19 patients. Pneumonia, radiological severity, oxygen, intensive care requirements, mortality, ESR, and other acute-phase reactant values were recorded. Logistic regression and ROC analysis identified the effect of ESR on mortality and the sensitivity and specificity of the optimal cutoff values of ESR for the prediction of pneumonia, intensive care needs, and mortality and compared these with values for CRP. Results Of patients, 346 (70.2%) had pneumonia, 98 (19.9%) required intensive care, 183 (37.1%) required oxygen support, and 62 (12.6%) died. ESR data were obtained for 278 patients. Among patients, 80.2% had ESR above 20 mm/h, with a median value of 53 (interquartile range: 49). ESR was higher among those with pneumonia (p < 0.001), requiring oxygen (p < 0.001), and requiring intensive care (p=0.003) compared to those without these, and in exitus patients (p=0.043) compared to survivors. Logistic regression analysis identified that ESR did not impact mortality. ROC analysis found the AUC, cutoff, sensitivity, and specificity results of ESR for pneumonia were 0.827, 37 mm/h, 77%, and 78%; for intensive care were 0.625, 50 mm/h, 74%, and 52; and for mortality were 0.606, 51 mm/h, 71%, and 49%, respectively. However, ROC analysis values for CRP were superior to ESR for all these categories. Conclusion ESR increased in COVID-19 patients in the presence of pneumonia and severe disease; however, it was not prognostic. Sensitivity and specificity values for pneumonia, intensive care requirements, and mortality were lower than those for CRP.

Comparing Interleukin-6, C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count for the Early Diagnosis of Acute Pyelonephritis in Children

Background: Urinary tract infection (UTI) is common in children. Differentiating lower UTI from acute pyelonephritis (APN) is of great importance in children since early diagnosis and timely management can prevent kidney scarring and associated complications. Objectives: We aimed to compare the diagnostic performance of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count with interleukin-6 (IL-6) for the diagnosis of APN in children. Methods: This cross-sectional study included 38 children with APN (based on clinical findings and positive urine culture) aged 1 month to 15 years admitted to Bandar Abbas Pediatric Hospital, Bandar Abbas, Iran, during 2019-2020. Serum CRP, WBC, IL-6, and WBC count were measured in all children. Age and sex of the participants were also recorded. Results: The mean ± SD age of the children was 65.82±46.67 months, of whom 23 (60.5%) were girls. The sensitivity of WBC, ESR, CRP, and IL-6 for the early diagnosis of APN was 39.5%, 71.1%, 60.5%, and 71.1%, respectively. Taking the results of ESR, CRP, and WBC into account as the basis of diagnosis, altogether 9.98 pg/mL was the best cut-off of serum IL-6 for the diagnosis of APN with 70%-80% sensitivity and 56.5%-73.7% specificity. A significant correlation was found between serum IL-6 and CRP, ESR, and WBC with the strongest correlation between IL-6 and CRP (r=0.451, P=0.004). Age and sex did not affect these correlations. The sensitivity of serum IL-6 at the 5 pg/mL cut-off for the diagnosis of APN was higher in boys and children younger than 6 years. Conclusion: IL-6 can diagnose APN in children aged 1 month to 15 years with 71.1% sensitivity. Its sensitivity is superior to CRP and WBC and comparable with ESR in this regard.

The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections

BackgroundFibrinogen (FIB) has been found to be a promising marker in diagnosing periprosthetic joint infection (PJI), however, the value of FIB in predicting reinfection of PJI is unknown. The purpose of this study was to evaluate the value of FIB in predicting reinfection after debridement, antibiotics, and implant retention (DAIR) for PJI.MethodsWe retrospectively analyzed the clinical data of patients who were diagnosed with PJI and underwent DAIR from 2013 to 2019. The levels of the FIB, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured before DAIR. After DAIR, patients were followed and reinfections were identified. For both acute and chronic PJI, the predictive value of FIB was evaluated by calculating the sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic curve (ROC), and was compared with traditional inflammatory markers including ESR and CRP.ResultsThe expression of FIB differed between patients reinfected and those not reinfected in both acute and chronic PJI (p < 0.05). In patients who underwent DAIR for acute PJI, the sensitivity and specificity of FIB were 81.82 and 83.33%, respectively, which were significantly higher than that of CRP (sensitivity, 72.73%; specificity, 50%; p < 0.05), while the specificity was higher than that of ESR (specificity, 41.67%; p < 0.05). In patients who underwent DAIR for chronic PJI, the sensitivity and specificity of FIB were 80.00 and 66.66%, respectively, which were significantly higher than that of CRP (sensitivity, 53.33%; specificity, 66.66%; p < 0.05) and ESR (sensitivity was 66.00%; specificity, 16.66%; p < 0.05). The ROC curves showed that FIB demonstrated the highest AUC among the biomarkers in both acute and chronic PJI.ConclusionFIB is a promising indicator in predicting reinfection after DAIR for both acute and chronic PJI, and it seems to perform better than ESR and CRP.

Faible valeur du rapport nombre de plaquettes sur le volume plaquettaire moyen pour les diagnostics des infections péri-prothétiques : étude cas témoin

IntroductionNumerous tests are being evaluated in order to aid the diagnosis of periprosthetic infections since it is a complicated and sometimes inconclusive process. The purpose of this study was to assess the diagnostic performance of platelet count to mean platelet volume ratio as a tool to aid the diagnosis of periprosthetic joint infections. The investigated questions were: “Is platelet count/mean platelet volume ratio more sensitive or specific than C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) in the diagnosis of periprosthetic joint infections?” and “Does platelet count/mean platelet volume ratio increase the accuracy of periprosthetic joint infection diagnosis?”. HypothesisPlatelet count/mean platelet volume ratio increases the accuracy of periprosthetic joint infection diagnosis. Materials and methodsThis study was performed retrospectively on patients who underwent revision hip or knee arthroplasty between 2016 and 2019. 62 patients with 33 aseptic (AR) and 29 septic revision (SR) who met our inclusion criteria were included. The sensitivity, specificity and diagnostic performance of CRP, ESR and platelet count/mean platelet volume values were analyzed and compared. ResultsThe demographic characteristics were similar between groups. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly encountered microorganisms, while seven patients had negative cultures in SR group. ESR, CRP and platelet count/mean platelet volume values were significantly higher in SR group compared to AR group (p<0.01). ROC analysis for platelet count/mean platelet volume ratio revealed a cut-off value at 35.3 which provided 75.9 % sensitivity and 78.8 % specificity for periprosthetic joint infections. Platelet count/mean platelet volume ratio yielded lower sensitivity and similar specificity compared to ESR and CRP values. Platelet count/mean platelet volume had a lower area under curve value, indicating a poorer diagnostic performance compared to ESR and CRP. DiscussionThe diagnostic performance of platelet count/mean platelet volume ratio is low and current findings do not support its usage to increase the accuracy of periprosthetic joint infections diagnosis. Level of evidenceIII; diagnostic case-control study.

Low value of platelet count to mean platelet volume ratio to diagnose chronic PJI: A case control study

IntroductionNumerous tests are being evaluated in order to aid the diagnosis of periprosthetic infections since it is a complicated and sometimes inconclusive process. The purpose of this study was to assess the diagnostic performance of platelet count to mean platelet volume ratio as a tool to aid the diagnosis of periprosthetic joint infections. The investigated questions were: “Is platelet count/mean platelet volume ratio more sensitive or specific than C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) in the diagnosis of periprosthetic joint infections?” and “Does platelet count/mean platelet volume ratio increase the accuracy of periprosthetic joint infection diagnosis?”. HypothesisPlatelet count/mean platelet volume ratio increases the accuracy of periprosthetic joint infection diagnosis. Materials and methodsThis study was performed retrospectively on patients who underwent revision hip or knee arthroplasty between 2016 and 2019. 62 patients with 33 aseptic (AR) and 29 septic revision (SR) who met our inclusion criteria were included. The sensitivity, specificity and diagnostic performance of CRP, ESR and platelet count/mean platelet volume values were analyzed and compared. ResultsThe demographic characteristics were similar between groups. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly encountered microorganisms, while seven patients had negative cultures in SR group. ESR, CRP and platelet count/mean platelet volume values were significantly higher in SR group compared to AR group (p<0.01). ROC analysis for platelet count/mean platelet volume ratio revealed a cut-off value at 35.3 which provided 75.9% sensitivity and 78.8% specificity for periprosthetic joint infections. Platelet count/mean platelet volume ratio yielded lower sensitivity and similar specificity compared to ESR and CRP values. Platelet count/mean platelet volume had a lower area under curve value, indicating a poorer diagnostic performance compared to ESR and CRP. DiscussionThe diagnostic performance of platelet count/mean platelet volume ratio is low and current findings do not support its usage to increase the accuracy of periprosthetic joint infections diagnosis. Level of evidenceIII; diagnostic case-control study.

Exciting Performance of Plasma Fibrinogen in Periprosthetic Joint Infection Diagnosis.

ObjectiveTo test the significance of serum C‐reactive protein (CRP), the erythrocyte sedimentation rate (ESR), the platelet count/mean platelet volume ratio (PC/MPV), plasma fibrinogen, and D‐Dimer in periprosthetic joint infection (PJI) diagnosis.MethodsWe retrospectively analyzed the clinical data of 149 patients diagnosed from July 2016 to December 2019 with primary osteoarthritis (OA group, average age 63.18 years [range, 53–82 years] 18 males, 46 females), PJI (PJI group, average age 63.74 years [range, 52–81 years], 16 males, 31 females), and aseptic loosening (aseptic group, average age 63.18 years [range, 53–80 years], 12 male, 26 female) in our department. Demographic data and the sensitivity and specificity of preoperative CRP, ESR, PC/MPV, fibrinogen, and D‐Dimer in PJI diagnosis were compared.ResultsThere were no significant differences when the demographic data of the three groups were compared. The expression level of CRP (50.67 ± 58.98 mg/L), ESR (50.55 ± 25.81 mm/h), PC/MPV (35.79 ± 18.00), and fibrinogen (4.85 ± 1.33 μg/mL) in the PJI group were higher than in the OA group (CRP: 4.09 ± 9.68 mg/L; ESR:13.44 ± 9.32 mm/1 h; PC/MPV: 24.97 ± 7.58; fibrinogen: 3.09 ± 0.55 μg/mL) and the aseptic group (CRP: 7.01 ± 11.83 mg/L; ESR: 22.47 ± 17.53 mm/1 h; PC/MPV: 25.18 ± 11.48; fibrinogen: 3.39 ± 0.80 μg/mL), respectively. The expression level of plasma D‐dimer (1.60 ± 1.29 mg/L) in the PJI group was higher than in the OA group (0.49 ± 0.42 mg/L) but similar to that in the aseptic group (1.21 ± 1.35 mg/L). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, PC/MPV, fibrinogen, and D‐dimer were 0.892 (95% confidence interval, 0.829–0.954), 0.888 (0.829–0.947), 0.686 (0.589–0.784), 0.873 (0.803–0.943), and 0.835 (0.772–0.899), respectively. When PC/MPV > 31.70, fibrinogen >4.01 μg/mL, and D‐dimer >1.17 mg/L were set as the threshold values for the diagnosis of PJI, the sensitivity of PC/MPV in PJI diagnosis was lower than that of ESR and plasma fibrinogen. In contrast, there was no significant difference when comparing the specificity of CRP, ESR, PC/MPV, fibrinogen, and D‐dimer in PJI diagnosis.ConclusionPlasma fibrinogen is a good new auxiliary diagnostic marker for PJI.

Variation in Inflammatory Biomarkers Among Demographic Groups Significantly Affects Their Accuracy in Diagnosing Periprosthetic Joint Infection

BackgroundDiagnosis of periprosthetic joint infection (PJI) is a multistep process that involves performing various tests including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The latter two tests, despite being used at all times for PJI diagnosis, are known to be nonspecific and substantially affected by demographic characteristics, including age, gender, race, and body mass index. It is unknown how these variations affect the diagnostic utility of serological markers for PJI. MethodsInstitutional databases were queried to identify patients undergoing revision arthroplasty between 2010 and 2018, in whom preoperative serum ESR and CRP was performed. Patient demographics were collected, and patients were cross-referenced with an internal database to determine their infection status. Analyses were performed to determine how ESR and CRP varied with respect to demographic factors, including age, gender, race, and infection status. Given that patient infection status was known at the time of revision, conclusions were drawn about the effect of these variations in inflammatory markers on the diagnostic utility of ESR and CRP. ResultsThe value of ESR increased by age was higher in females and African American race. No significant differences were observed in the value of CRP among the demographic factors, although a slight positive trend was observed with respect to age. The variation in inflammatory markers significantly affected the sensitivity, specificity, and accuracy of ESR and CRP for PJI diagnosis. ConclusionUnderstanding how the accuracy of diagnostic tests varies with respect to demographic factors can help physicians avoid subjecting patients to unnecessary additional testing and reach more accurate diagnoses of PJI.

Elevated ESR/CRP Ratio Is Associated With Reinfection After Debridement, Antibiotics, and Implant Retention in Chronic Periprosthetic Joint Infections

Ratios of established inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), have been used for diagnostic purposes in the surgical field; however, the ESR:CRP ratio (ECR) has not been evaluated as a marker for predicting infection resolution in patients with periprosthetic joint infections (PJIs). This study aimed to evaluate the diagnostic accuracy of ECR in predicting postoperative reinfection in patients who underwent debridement, antibiotics, and implant retention (DAIR). This is a retrospective review of 179 consecutive patients who underwent DAIR revision total joint arthroplasty for PJI. Patients were stratified by acuity of their infection: acute PJI, acute hematogenous PJI, and chronic PJI. The area under the receiver operating characteristic curve was calculated to evaluate ECR as diagnostic marker for predicting postoperative reinfection in patients who underwent DAIR. Statistically significant differences in ECR were found in patients who underwent DAIR revision total joint arthroplasty for chronic infection (1.23 vs 2.33; P= .04). There was no significant difference in ECR in patients who underwent DAIR for acute infection (P= .70) and acute hematogenous infection (P= .56). In patients who underwent DAIR for chronic PJI, ECR demonstrated a sensitivity and specificity of 75% and 84%, respectively, for the prediction of postoperative reinfection, which was significantly higher than that of ESR (sensitivity, 67%; specificity, 47%; P < .001) and CRP (sensitivity, 50%; specificity, 26%; P < .001). Elevated ECR was associated with an increased reinfection risk in patients who underwent DAIR for chronic PJI, suggesting that preoperative ECR may be a useful predictor to identify patients at increased risk of reinfection after DAIR for chronic PJIs.

Role of C-reactive protein and erythrocyte sedimentation rate to predict difficult laproscopic cholecystectomy in a university residency program

Background: laparoscopic cholecystectomy is one of the most common procedures performed in general surgery. The anatomical differences of the gallbladder and the presence of factors related to inflammation can cause technical issues during surgery. Objective: the aim of the present study was to determine the value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as predictors of difficult cholecystectomy and to evaluate their application during presurgical planning within a university residency program. Material and methods: we conducted a retrospective and analytical study in a tertiary university hospital. A total of 104 adult patients undergoing laparoscopic cholecystectomy due to symptomatic cholelithiasis between January and July 2019 were included. The patients were categorized into two groups: difficult cholecystectomy and non-difficult cholecystectomy. Results: there were statistically significant differences in ESR and CRP values between both groups (p &lt; 0.001). Sensitivity of ESR was 100%, specificity was 45%, with a PPV of 40% and NPV of 100%. Sen- sitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Both parameters were elevated in 14 of 16 difficult cholecystectomies and in 2 of 44 non-difficult cholecystectomies. Sensitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Conclusion: measuring ESR and CRP has proved to be a reliable method to predict difficult chole- cystectomies due to symptomatic cholelithiasis. This could be applied for surgical planning within a university residency program.

A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections

BackgroundThe accurate non-invasive diagnosis of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis has not been achieved yet. The aim of the study was to obtain an unmistakable diagnosis of SBP using a new simple serum bioscore, made by combined measurement of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which we called the PEC index. This cross-sectional analytic study comprised 178 cirrhotic patients with ascites (60 patients with SBP and 118 patients with sterile ascites), after excluding non-SBP infection, during the period from March 2019 until September 2019. In all participants, serum levels of PCT, ESR, and CRP were measured, and PEC index was calculated [PEC index = PCT × (ESR + CRP)].ResultsPatients with SBP (n = 60) had significantly higher serum PEC index than those with sterile ascites (n = 118) (41.0/31.2–93.0 vs. 9.9/5.9–15.0, P < 0.001). PEC index distinguished culture positive cases significantly (P < 0.001). Using receiver operating characteristic (ROC) statistics, the sensitivity and specificity of PCT, at a cutoff value of 0.590 ng/mL, for SBP diagnosis, were 81.67% and 93.33%, respectively (area under the curve [AUC] = 0.879; 95% confidence interval [CI] 0.809–0.948). The sensitivity and specificity of ESR, at a cutoff value of 27.0 mm/hour, were 73.33% and 61.67%, respectively (AUC = 0.679; 95% CI 0.581–0.776). The sensitivity and specificity of CRP, at a cutoff value of 21.0 mg/L, were 93.33% and 51.67%, respectively (AUC = 0.736; 95% CI 0.639–0.833). While, the sensitivity and specificity of PEC index, at a cutoff value of 20, were highest (98.33% and 96.67%, respectively, AUC = 0.977; 95% CI 0.940–0.996).ConclusionSerum PEC index makes an accurate noninvasive diagnosis of SBP, after excluding other infections.

Serum interleukin 6 could be a valuable initial diagnostic tool in prosthetic knee joint infections.

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 9.14pg/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.

Platelet Function Tests and Inflammatory Markers for the Differentiation of Primary Thrombocytosis and Secondary Thrombocytosis.

Background:The prognosis and management of primary thrombocytosis (PT) and secondary thrombocytosis (ST) are different. This study aims to evaluate the role of platelet function tests by light transmission platelet aggregometry (LTA), plasma von Willebrand factor antigen (vWF:Ag), ristocetin cofactor activity (vWF:RCo) and inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation between PT and ST. Methods:This prospective study was carried out in patients with platelet counts greater than 450 x 109/L. Primary outcomes were the sensitivity and specificity of platelet function tests by LTA for the differentiation of PT and ST. Secondary outcomes were sensitivity and specificity of ESR, CRP, vWF:Ag, and vWF:RCo for the differentiation of PT and ST. Results:Fifty-two patients were enrolled onto the study of which 26 (50%) had PT. The sensitivity and specificity of epinephrine, collagen, and arachidonic acid (AA) induced abnormal LTA for the differentiation of PT from ST were sensitivity of 50%, 38.5%, 26.9% and specificity of 88.5%, 100%, 100% respectively. The sensitivity and specificity of abnormal ESR, CRP, and either abnormal ESR or CRP in the differentiation of ST from PT were sensitivity of 88.5%, 80.8%, 100% and specificity of 65.4%, 61.5%, 46.2% respectively. The sensitivity and specificity of low vWF:Ag and vWF:RCo in the differentiation of PT from ST were sensitivity of 7.69%, 42.3% and specificity of 100%, 88.5% respectively. Conclusions:Abnormal platelet function determined by LTA with collagen, AA, epinephrine had high specificity ratings enabling the differentiation between PT and ST. vWF:RCo, ESR and CRP levels could be helpful in differentiating between PT and ST.

Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation.

Despite the availability of a battery of tests, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities that occur during infection. We hypothesized that patients with PJI may have a high level of circulating D-dimer and that the presence of a high level of serum D-dimer may be a sign of persistent infection in patients awaiting reimplantation. This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty. Our cohort consisted of 245 patients undergoing primary arthroplasty (n = 23), revision for aseptic failure (n = 86), revision for PJI (n = 57), or reimplantation (n = 29) or who had infection in a site other than a joint (n = 50). PJI was defined using the Musculoskeletal Infection Society criteria. In all patients, serum D-dimer level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were measured preoperatively. The median D-dimer level was significantly higher (p < 0.0001) for the patients with PJI (1,110 ng/mL [range, 243 to 8,487 ng/mL]) than for the patients with aseptic failure (299 ng/mL [range, 106 to 2,571 ng/mL). Using the Youden index, 850 ng/mL was determined as the optimal threshold value for serum D-dimer for the diagnosis of PJI. Serum D-dimer outperformed both ESR and serum CRP, with a sensitivity of 89% and a specificity of 93%. ESR and CRP had a sensitivity of 73% and 79% and a specificity of 78% and 80%, respectively. The sensitivity and specificity of ESR and CRP combined was 84% (95% confidence interval [CI], 76% to 90%) and 47% (95% CI, 36% to 58%), respectively. It appears that serum D-dimer is a promising marker for the diagnosis of PJI. This test may also have a great utility for determining the optimal timing of reimplantation. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Guillain-Barré Syndrome Independent of Infection

Objective: In the present study, we aimed to determine the predictive value of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of Guillain-Barre Syndrome (GBS). Material and Methods: This retrospective study enrolled 94 GBS patients and a control group of 101 healthy subjects. Results: GBS patients had significantly higher NLR, C- Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) values at presentation than the healthy control group (p < 0.001, p < 0.001, p < 0.001, respectively). Patients unresponsive to IVIg therapy had significantly higher NLR values at the time of admission in comparison to responsive patients (p=0.001). NLR was significantly and positively correlated with the disease severity, CRP and ESR. A receiver operating characteristic (ROC) analysis of the ability of NLR to predict GBS showed a cutoff value of 3.5 (sensitivity 62.8%, specificity 90.1%). The cutoff value was 11 for CRP (sensitivity 52.7%, specificity 86%) and 12.3 for ESR (sensitivity 51.3%, specificity 82%). Exclusion of patients with signs of infection at presentation gave a NLR value of 3.2, which had a sensitivity of 61.6% and a specificity of 89.8% for predicting GBS. Conclusion: Whereas ESR and CRP lost their significance in predicting GBS. Unlike ESR and CRP, NLR might be a promising marker in GBS regardless of infection.