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Diagnostic accuracy of interleukin-6 and procalcitonin in patients with periprosthetic joint infection: a systematic review and meta-analysis

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Abstract

Purpose

Many studies have found associations between laboratory biomarkers and periprosthetic joint infection (PJI), but it remains unclear whether these biomarkers are clinically useful in ruling out PJI. This meta-analysis compared the performance of interleukin-6 (IL-6) versus procalcitonin (PCT) for the diagnosis of PJI.

Methods

In this meta-analysis, we reviewed studies that evaluated IL-6 or/and PCT as a diagnostic biomarker for PJI and provided sufficient data to permit sensitivity and specificity analyses for each test. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through February 28, 2017. No restrictions were placed on language of publication.

Results

We identified 18 studies encompassing a total of 1,835 subjects; 16 studies reported on IL-6 and 6 studies reported on PCT. The area under the curve (AUC) was 0.93 (95% CI, 0.91–0.95) for IL-6 and 0.83 (95% CI, 0.79–0.86) for PCT. The pooled sensitivity was 0.83 (95% CI, 0.74–0.89) for IL-6 and 0.58 (95% CI, 0.31–0.81) for PCT. The pooled specificity was 0.91 (95% CI, 0.84–0.95) for IL-6 and 0.95 (95% CI, 0.63–1.00) for PCT. Both the IL-6 and PCT tests had a high positive likelihood ratio (LR); 9.3 (95% CI, 5.3–16.2) and 12.4 (95% CI, 1.7–89.8), respectively, making them excellent rule-in tests for the diagnosis of PJI. The pooled negative LR for IL-6 was 0.19 (95% CI, 0.12–0.29), making it suitable as a rule-out test, whereas the pooled negative LR for PCT was 0.44 (95% CI, 0.25–0.78), making it unsuitable as a rule-out diagnostic tool.

Conclusions

Based on the results of the present meta-analysis, IL-6 has higher diagnostic value than PCT for the diagnosis of PJI. Moreover, the specificity of the IL-6 test is higher than its sensitivity. Conversely, PCT is not recommended for use as a rule-out diagnostic tool.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea

    Jung-Ro Yoon, Se-Hyun Yang & Young-Soo Shin

Authors
  1. Jung-Ro Yoon
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  2. Se-Hyun Yang
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  3. Young-Soo Shin
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Correspondence to Young-Soo Shin.

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The authors declare that they have to no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

There are no conflicts of interest between any of the contributors to this manuscript.

Additional information

Research of this study was performed at Veterans Health Service Medical Center.

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Yoon, JR., Yang, SH. & Shin, YS. Diagnostic accuracy of interleukin-6 and procalcitonin in patients with periprosthetic joint infection: a systematic review and meta-analysis. International Orthopaedics (SICOT) 42, 1213–1226 (2018). https://doi.org/10.1007/s00264-017-3744-3

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  • DOI: https://doi.org/10.1007/s00264-017-3744-3

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