Procalcitonin and α-Defensin for Diagnosis of Periprosthetic Joint Infections

Background: Current methods to diagnose periprosthetic joint infection (PJI) before revision surgery have limited diagnostic accuracy. This meta-analysis was performed to estimate the accuracy of procalcitonin (PCT) and alpha-defensin for the diagnosis of PJI. Methods: Articles on the diagnostic value of PCT or alpha-defensin for PJI diagnosis were searched in the PubMed database. Sensitivity, specificity, diagnostic odds ratio, the area under the curve of summary receiver operating characteristic curves (AUC), the positive likelihood ratio, and the negative likelihood ratio were calculated to evaluate the diagnostic ability of PCT and the alpha-defensin test for the diagnosis of PJI. Results: The pooled sensitivities for detecting PJI using PCT and alpha-defensin were 0.53 (95% confidence interval [CI], 0.24-0.80) and 0.96 (95% CI, 0.85-0.99), respectively. The pooled specificities for detecting PJI using PCT and alpha-defensin were 0.92 (95% CI, 0.45-0.99) and 0.95 (95% CI, 0.89-0.98), respectively. The pooled diagnostic odds ratios for detecting PJI using PCT and alpha-defensin were 13 (95% CI, 3-70) and 496 (95% CI, 71-3456), respectively. The pooled AUCs for PCT and alpha-defensin were 0.76 (95% CI, 0.72-0.80) and 0.99 (95% CI, 0.97-0.99), respectively. The positive likelihood ratio and the negative likelihood ratio of PCT were 6.8 (95% CI, 1.0-48.1) and 0.51 (95% CI, 0.31-0.84), respectively, whereas those of alpha-defensin were 19.6 (95% CI, 8.2-46.8) and 0.04 (95% CI, 0.01-0.17), respectively. Conclusion: Synovial fluid alpha-defensin has a great potential to diagnose PJI. (C) 2016 Elsevier Inc. All rights reserved.