Table 3 Diagnostic value of different diagnostic method for the diagnosis of PJI
Diagnostic method | Study | Sensitivity (95% CI) | Specificity (95% CI) | PLR (95% CI) | NLR (95% CI) | DOR (95% CI) | AUC (95% CI) |
|---|---|---|---|---|---|---|---|
Synovial fluid biomarkers and aspiration culture | |||||||
Aspiration culture | Qu et al., 2013 [8] | 0.72 (0.65–0.78) | 0.95 (0.93–0.97) | 15.3 (10.6–22.1) | 0.29 (0.23–0.38) | 52.00 (31.00–86.00) | 0.94 (0.92–0.96) |
White cell count | Qu et al., 2014 [52] | 0.88 (0.81–0.93) | 0.93 (0.88–0.96) | 13.30 (7.70–22.80) | 0.13 (0.08–0.21) | 103.00 (54.00–197.00) | 0.96 (0.94–0.98) |
Polymorphonuclear | Qu et al., 2014 [52] | 0.90 (0.84–0.93) | 0.88 (0.83–0.92) | 7.60 (4.90–11.70) | 0.12 (0.07–0.19) | 64.00 (27.00–149.00) | 0.95 (0.93–0.96) |
C-reactive protein | Wang et al., 2016 [53] | 0.92 (0.86–0.96) | 0.90 (0.87–0.93) | 9.00 (6.15–13.16) | 0.10 (0.06–0.18) | 101.40 (48.07–213.93) | 0.97 NA |
Leukocyte esterase | Wyatt et al., 2016 [34] | 0.81 (0.49–0.95) | 0.97 (0.82–0.99) | 23.90 (3.80–152.10) | 0.19 (0.06–0.66) | NA | 0.97 (0.95–0.98) |
Interleukin-6 | Xie et al., 2017 [54] | 0.91 (0.82–0.96) | 0.90 (0.84–0.95) | 9.50 (5.40–17.20) | 0.09 (0.04–0.21) | 101.00 (28.00–358.00) | 0.96 (0.94–0.98) |
Alpha-defensin (Immunoassay) | Current study | 0.96 (0.90–0.98) | 0.97 (0.95–0.99) | 35.0 (18.5–66.2) | 0.04 (0.02–0.11) | 811 (220–2290) | 0.99 (0.98–1.00) |
Alpha-defensin (lateral flow test) | Current study | 0.86 (0.81–0.91) | 0.96 (0.93–0.98) | 21.2 (11.7–38.5) | 0.14 (0.10–0.21) | 148 (64–343) | 0.95 (0.93–0.97) |
Serum biomarkers | |||||||
White cell count | Berbari et al., 2010 [55] | 0.45 (0.41–0.49) | 0.87 (0.85–0.89) | NA | NA | 4.40 (2.90–6.60) | NA |
Erythrocyte sedimentation rate | Berbari et al., 2010 [55] | 0.75 (0.72–0.77) | 0.70 (0.68–0.72) | NA | NA | 7.20 (4.70–10.90) | NA |
C-reactive protein | Yuan et al., 2014 [56] | 0.82 (0.80–0.84) | 0.77 (0.76–0.78) | 3.66 (2.92–4.59) | 0.26 (0.20–0.33) | 17.01 (11.38–25.44) | 0.88 (0.86–0.89) |
Procalcitonin | Xie et al., 2017 [33] | 0.53 (0.24–0.80) | 0.92 (0.45–0.99) | 6.80 (1.00–48.10) | 0.51 (0.31–0.84) | 13.00 (3.00–70.00) | 0.76 (0.72–0.80) |
Interleukin-6 | Xie et al., 2017 [54] | 0.72 (0.63–0.80) | 0.89 (0.77–0.95) | 6.40 (2.90–14.10) | 0.31 (0.22–0.44) | 20.00 (7.00–58.00) | 0.83 (0.79–0.86) |
Nuclear medicine | |||||||
Bone scintigraphy | Ouyang et al., 2014 [57] | 0.83 (0.72–0.90) | 0.73 (0.65–0.80) | 3.10 (2.40–4.10) | 0.23 (0.14–0.38) | 14.00 (7.00–26.00) | 0.85 (0.81–0.87) |
Anti-granulocyte scintigraphy | Xing et al., 2013 [58] | 0.83 (0.79–0.87) | 0.79 (0.75–0.83) | 3.56 (2.42–5.23) | 0.26 (0.19–0.37) | 18.76 (10.45–33.68) | 0.88 NA |
Leukocyte scintigraphy | Verbern et al., 2016 [59] | 0.88 NA | 0.92 NA | NA | NA | NA | NA |
FDG-PET | Verbern et al., 2016 [59] | 0.86 NA | 0.93 NA | NA | NA | NA | NA |
Other tests with biopsy | |||||||
Frozen section histopathology | Tsaras et al., 2012 [51] | NA | NA | 12.00 (8.40–17.20) | 0.23 (0.15–0.35) | 54.7 (31.2–95.7) | NA |
PCR assays | Qu et al., 2014 [52] | 0.86 (0.77–0.92) | 0.91 (0.81–0.96) | 9.10 (4.60–18.20) | 0.16 (0.10–0.25) | 59.00 (29.00–118.00) | 0.94 (0.91–0.95) |
Sonication fluid cultures | Zhai et al., 2014 [60] | 0.80 (0.74–0.84) | 0.95 (0.90–0.98) | 17.20 (7.60–38.70) | 0.21 (0.17–0.27) | 81.00 (35.00–186.00) | 0.89 (0.86–0.91) |
Gram staining | Ouyang et al., 2015 [61] | 0.19 (0.12–0.27) | 1.00 (0.99–1.00) | 41.60 (15.50–111.20) | 0.82 (0.75–0.89) | 51.00 (18.00–140.00) | 0.89 (0.86–0.91) |