The Diagnostic Value of Various Inflammatory Biomarkers for Diagnosing Periprosthetic Joint Infection is Gender-Specific

Figures & data

Table 1 Demographic Characteristics of All Patients

	Female		P value	Male		P value
	PJI^a (n=41)	Non-PJI (n=69)		PJI (n=39)	Non-PJI (n=67)
Age (y)	65.00±10.39	66.00±9.98	0.622	64.21±9.73	64.21±9.50	0.998
BMI^b (kg/m^2)	26.14±4.36	24.39±3.43	0.032	25.49±3.85	25.02±3.54	0.536
Joint			0.003			<0.001
Knee	25	22		17	5
Hip	16	47		22	62

Abbreviations: ^aPJI, periprosthetic joint infection; ^bBMI, body mass index.

Table 2 Comparison of the Levels of Biomarkers in Different Genders

	Female		P value	Male		P value
	PJI^a (n=41)	Non-PJI (n=69)		PJI (n=39)	Non-PJI (n=67)
CRP^b (mg/L)	28.4(39.2)	1.4(3.0)	<0.001	19.0(32.1)	2.9(4.5)	<0.001
Fibrinogen (g/L)	4.5(1.7)	2.8(0.8)	<0.001	4.5(1.7)	7.3(6.1)	<0.001
D-dimer (ng/mL)	750.0(870.0)	400.0(290.0)	<0.001	910.0(940.0)	500.0(360.0)	<0.001
ESR^c (mm/h)	45.0(42.7)	12.0(10.9)	<0.001	36.0(35.0)	7.3(6.1)	<0.001
CRP/albumin	0.7(1.1)	0.1(0.1)	<0.001	0.6(0.8)	0.1(0.1)	<0.001

Abbreviations: ^aPJI, periprosthetic joint infection; ^bCRP, C-reactive protein; ^cESR, erythrocyte sedimentation rate.

Table 3 The Diagnostic Value of Biomarkers in Female PJI

	AUC	95% CI	Youden Index	Cut-Off Value	Sensitivity	Specificity	PPV^a	NPV^b
CRP^c (mg/L)	0.98	(0.951,1.000)	0.859	8.86	90.2%	95.7%	92.5%	94.3%
Fibrinogen (g/L)	0.89	(0.826,0.953)	0.694	3.54	85.4%	84.1%	76.1%	90.6%
D-dimer (ng/mL)	0.79	(0.705,0.879)	0.456	605.00	65.9%	79.7%	65.9%	79.7%
ESR^d (mm/h)	0.93	(0.882,0.976)	0.733	27.50	87.8%	85.5%	78.3%	92.2%
CRP/albumin	0.96	(0.914,1.000)	0.844	0.22	90.2%	94.2%	90.2%	94.2%

Abbreviations: ^aPPV, positive predictive value; bNPV, negative predictive value; ^cCRP, C-reactive protein; ^dESR, erythrocyte sedimentation rate.

Figure 1 The ROC curves of plasma CRP, fibrinogen, D-dimer, ESR, and CRP/albumin in female PJI. Among the biomarkers, the AUC of CRP was the largest, and that of D-dimer was the smallest (A). CRP+ CRP/albumin had the best ability to diagnose PJI, while CRP+ESR was the worst (B).

Table 4 The Diagnostic Value of Biomarkers in Male PJI

	AUC	95% CI	Youden Index	Cut-Off Value	Sensitivity	Specificity	PPV^a	NPV^b
CRP^c(mg/L)	0.83	(0.824,0.959)	0.680	10.64	76.9%	91.0%	83.3%	87.1%
Fibrinogen (g/L)	0.87	(0.799,0.937)	0.620	3.80	76.9%	85.1%	78.6%	90.6%
D-dimer (ng/mL)	0.76	(0.662,0.862)	0.432	1070.00	46.2%	97.0%	74.4%	85.1%
ESR^d (mm/h)	0.92	(0.874,0.974)	0.712	14.50	84.6%	86.6%	94.7%	75.9%
CRP/albumin	0.91	(0.867,0.973)	0.746	0.31	82.1%	92.5%	86.5%	89.9%

Abbreviations: ^aPPV, positive predictive value; ^bNPV, negative predictive value; ^cCRP, C-reactive protein; ^dESR, erythrocyte sedimentation rate.

Figure 2 The ROC curves of plasma CRP, fibrinogen, D-dimer, ESR, and CRP/albumin in male PJI. Among the biomarkers, the AUC of ESR was the largest, and that of D-dimer was the smallest (A). ESR+ CRP/albumin had the best ability to diagnose PJI, while ESR+D-dimer was the worst (B).

Table 5 The Comparison of Sensitivity and Specificity Between Biomarkers in Female PJI

	Sensitivity	Specificity	PPV^a	NPV^b
CRP^c with ESR^d
CRP and ESR	85.4%	97.1%	94.6%	91.8%
CRP OR ESR	92.7%	84.1%	77.6%	95.1%
CRP with Fibrinogen
CRP and Fibrinogen	78.0%	98.6%	97.0%	88.3%
CRP OR Fibrinogen	97.6%	81.2%	75.5%	98.2%
CRP with D-dimer
CRP and D-dimer	58.5%	100%	100.0%	80.2%
CRP or D-dimer	97.6%	75.4%	70.2%	98.1%
CRP with CRP/albumin
CRP and CRP/albumin	82.9%	95.7%	91.9%	90.4%
CRP or CRP/albumin	97.6%	94.2%	90.9%	98.5%

Abbreviations: ^aPPV, positive predictive value; ^bNPV, negative predictive value; ^cCRP, C-reactive protein; ^dESR, erythrocyte sedimentation rate.

Table 6 The Comparison of Sensitivity and Specificity Between Biomarkers in Male PJI

	Sensitivity	Specificity	PPV^a	NPV^b
ESR^c with CRP^d
ESR and CRP	64.1%	94.0%	86.2%	81.8%
ESR OR CRP	97.4%	83.6%	77.6%	98.2%
ESR with Fibrinogen
ESR and Fibrinogen	66.7%	92.5%	83.9%	82.7%
ESR OR Fibrinogen	94.9%	79.1%	72.5%	96.4%
ESR with D-dimer
ESR and D-dimer	46.2%	98.5%	94.7%	75.9%
ESR or D-dimer	84.6%	85.1%	76.7%	90.5%
ESR with CRP/albumin
ESR and CRP/albumin	69.2%	95.5%	90.0%	84.2%
ESR or CRP/albumin	97.4%	83.6%	77.6%	98.2%

Abbreviations: ^aPPV, positive predictive value; ^bNPV, negative predictive value; ^cESR, erythrocyte sedimentation rate; ^dCRP, C-reactive protein.