nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

24.10.2023 | Knee Revision Surgery

Neutrophil–Lymphocyte Ratio and Lymphocyte–Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis

verfasst von: Daniel Timothy Burchette, Mustafa Fatih Dasci, Beatriz Fernandez Maza, Philip Linke, Thorsten Gehrke, Mustafa Citak

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To investigate reported correlations between Neutrophil-to-Lymphocyte (NLR) and Lymphocyte-to-Monocyte (LMR) ratios and their value in diagnosis of chronic prosthetic joint infection (PJI) in a large cohort of patients from a single specialist hospital.

Methods

Diagnostic aspirations of 362 patients under investigation for PJI were identified. Of the included patients 185 patients received a final diagnosis of PJI and 177 were classed as aseptic. Established criteria (ICM 2018) were employed to define PJI. Included in the analysis are differential white cell counts, C-Reactive Protein (CRP), Synovial Leukocyte Count, Synovial Alpha-defensin ELISA and Synovial Leukocyte esterase activity.

Receiver-operator characteristic (ROC) curves were calculated for each of the available diagnostic tests together with the corresponding area under the curve values (AUC). Youden’s index was utilized to identify the optimal diagnostic threshold point for the NLR and LMR. Other diagnostic tests were evaluated as per the threshold values previously defined in the literature and specified in the ICM criteria.

Results

Using Youden’s Index to identify the optimal NLR cut-off within our cohort we established a value of 2.93. This yielded a sensitivity of 0.60 and specificity of 0.64. The area under the curve (AUC) of a receiving operator characteristics (ROC) curve was 0.625. Regarding the LMR the results demonstrate similar findings; a positive correlation with a diagnosis of infection but poor sensitivity and specificity. The AUC for LMR was 0.633 and was not superior to NLR (P = 0.753).

Conclusions

There is a significant correlation between higher Neutrophil–Lymphocyte and Lymphocyte–Monocyte ratios, and a diagnosis of PJI. The sensitivity and specificity of this calculation is poor and the does not add value to the diagnostic algorithm for PJI.

Level of evidence

Level III Retrospective Cohort analysis.

AAOS Diagnosis and prevention of periprosthetic joint infecctions: Clinical practice guideline.

Delcea C, Buzea CA, Dan GA (2019) The neutrophil to lymphocyte ratio in heart failure: a comprehensive review. Rom J Intern Med 57(4):296–314. https://doi.org/10.2478/rjim-2019-0018CrossRefPubMed

Festa E, Ascione T, Bernasconi A et al (2022) Diagnostic performance of neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio, and platelet to mean platelet volume ratio in periprosthetic hip and knee infections: a systematic review and meta-analysis. Diagnostics (Basel). https://doi.org/10.3390/diagnostics12092033CrossRefPubMed

Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M (2017) What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 10(1):12. https://doi.org/10.1186/s13104-016-2335-5CrossRefPubMedPubMedCentral

Gehrke T, Zahar A, Kendoff D (2013) One-stage exchange: it all began here. Bone Joint J 95-B(11 Suppl A):77–83 doi: https://doi.org/10.1302/0301-620X.95B11.32646

Goswami K, Parvizi J, Maxwell Courtney P (2018) Current recommendations for the diagnosis of acute and chronic PJI for hip and knee-cell counts, alpha-defensin, leukocyte esterase next-generation sequencing. Curr Rev Musculoskelet Med 11(3):428–438. https://doi.org/10.1007/s12178-018-9513-0CrossRefPubMedPubMedCentral

Inose H, Kobayashi Y, Yuasa M, Hirai T, Yoshii T, Okawa A (2020) Postoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery. J Orthop Surg (Hong Kong), 28(2):2309499020918402; https://doi.org/10.1177/2309499020918402

Klemt C, Tirumala V, Smith EJ, Xiong L, Kwon YM (2022) Complete blood platelet and lymphocyte ratios increase diagnostic accuracy of periprosthetic joint infection following total hip arthroplasty. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-04309-wCrossRefPubMed

Klemt C, Tirumala V, Smith EJ, Xiong L, Kwon YM (2023) Complete blood platelet and lymphocyte ratios increase diagnostic accuracy of periprosthetic joint infection following total hip arthroplasty. Arch Orthop Trauma Surg 143(3):1441–1449. https://doi.org/10.1007/s00402-021-04309-wCrossRefPubMed

10.

Lee JS, Kim NY, Na SH, Youn YH, Shin CS (2018) Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore) 97(26):e11138. https://doi.org/10.1097/MD.0000000000011138CrossRefPubMed

11.

Luo H, He L, Zhang G et al (2019) Normal reference intervals of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and systemic immune inflammation index in healthy adults: a large multi-center study from Western China. Clin Lab. https://doi.org/10.7754/Clin.Lab.2018.180715CrossRefPubMed

12.

Maimaiti Z, Xu C, Fu J, Chai W, Zhou Y, Chen J (2022) The potential value of monocyte to lymphocyte ratio, platelet to mean platelet volume ratio in the diagnosis of periprosthetic joint infections. Orthop Surg 14(2):306–314. https://doi.org/10.1111/os.12992CrossRefPubMed

13.

McMaster Arthroplasty C (2020) Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a 15-year, population-based cohort study. J Bone Joint Surg Am 102(6):503–509. https://doi.org/10.2106/JBJS.19.00537CrossRef

14.

McNally M, Sousa R, Wouthuyzen-Bakker M, et al. (2021) The EBJIS definition of periprosthetic joint infection. Bone Joint J, 103-B(1):18–25. https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1

15.

Moosazadeh M, Maleki I, Alizadeh-Navaei R et al (2019) Normal values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio among Iranian population: Results of Tabari cohort. Caspian J Intern Med 10(3):320–325. https://doi.org/10.22088/cjim.10.3.320CrossRefPubMedPubMedCentral

16.

Onder A, GizliCoban O, Surer Adanir A (2021) Elevated neutrophil-to-lymphocyte ratio in children and adolescents with attention-deficit/hyperactivity disorder. Int J Psychiatry Clin Pract 25(1):43–48. https://doi.org/10.1080/13651501.2020.1804940CrossRefPubMed

17.

Parvizi J, Gherke T (2018) International Concensus Meeting on Muskuloskeletal Infection(ed)^(eds). Journal of Arthroplasty, Philadelphia,

18.

Parvizi J, Tan TL, Goswami K, et al. (2018) The 2018 Definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty, 33(5):1309–1314 e1302, doi: https://doi.org/10.1016/j.arth.2018.02.078

19.

Shi W, Jiang Y, Tian H et al (2023) C-reactive protein-to-albumin ratio (CAR) and C-reactive protein-to-lymphocyte ratio (CLR) are valuable inflammatory biomarker combination for the accurate prediction of periprosthetic joint infection. Infect Drug Resist 16:477–486. https://doi.org/10.2147/IDR.S398958CrossRefPubMedPubMedCentral

20.

Sigmund IK, Holinka J, Staats K et al (2021) Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections. Int Orthop 45(4):837–846. https://doi.org/10.1007/s00264-020-04889-zCrossRefPubMed

21.

Templeton AJ, McNamara MG, Seruga B, et al. (2014) Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 106(6):dju124, doi: https://doi.org/10.1093/jnci/dju124

22.

Tirumala V, Klemt C, Xiong L, Chen W, van den Kieboom J, Kwon YM (2021) Diagnostic utility of platelet count/lymphocyte count ratio and platelet count/mean platelet volume ratio in periprosthetic joint infection following total knee arthroplasty. J Arthroplasty 36(1):291–297. https://doi.org/10.1016/j.arth.2020.07.038CrossRefPubMed

23.

Xu H, Xie J, Zhang S, Wang D, Huang Z, Zhou Z (2022) Potential blood biomarkers for diagnosing periprosthetic joint infection: a single-center. Retrospective Study Antibiotics (Basel). https://doi.org/10.3390/antibiotics11040505CrossRefPubMed

24.

Ye Y, Chen W, Gu M et al (2021) Limited value of serum neutrophil-to-lymphocyte ratio in the diagnosis of chronic periprosthetic joint infection. J Orthop Traumatol 22(1):37. https://doi.org/10.1186/s10195-021-00599-3CrossRefPubMedPubMedCentral

25.

Yu BZ, Fu J, Chai W, Hao LB, Chen JY (2020) Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection. BMC Musculoskelet Disord 21(1):706. https://doi.org/10.1186/s12891-020-03704-5CrossRefPubMedPubMedCentral

26.

Zhao G, Chen J, Wang J et al (2020) Predictive values of the postoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio for the diagnosis of early periprosthetic joint infections: a preliminary study. J Orthop Surg Res 15(1):571. https://doi.org/10.1186/s13018-020-02107-5CrossRefPubMedCentral

Titel: Neutrophil–Lymphocyte Ratio and Lymphocyte–Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis
verfasst von: Daniel Timothy Burchette
Mustafa Fatih Dasci
Beatriz Fernandez Maza
Philip Linke
Thorsten Gehrke
Mustafa Citak
Publikationsdatum: 24.10.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2024
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05052-0

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Neutrophil–Lymphocyte Ratio and Lymphocyte–Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis