Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections.
2021
Abstract. Introduction: The gold standard for determining the duration of
periprosthetic joint infection (PJI) is a thorough history. Currently, there
are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP
(mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion
criteria: patients >18 years old who underwent surgical revision
for PJI and had documented ESR and CRP values. Subjects were divided into
two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the
ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in
characterizing the duration of PJI.
Results: 147 patients were included in the study (81 acute and 66 chronic).
The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in
chronic patients ( p ). The ESR / CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for
ESR / CRP to predict a chronic ( >0.96 ) vs. acute ( ) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and
the specificity was 0.90 (95 % CI 0.81–0.94).
Conclusions: The ESR / CRP ratio may help determine the duration of PJI in
uncertain cases. This metric may give arthroplasty surgeons more confidence
in defining the duration of the PJI and therefore aid in treatment
selection.
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