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Presepsin as a diagnostic biomarker of peri-prosthetic joint infection: a review of the literature

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Abstract

Introduction

While presepsin has shown promise as a sepsis biomarker, it has only recently been considered in the field of orthopedic surgery. Therefore, the present review evaluates the role of presepsin in total joint arthroplasty (TJA) as well as its diagnostic and prognostic value in diagnosing PJI.

Methods

Utilizing 4 online databases, we thoroughly searched the literature for articles evaluating the role of presepsin in TJA as well as its prognostic and diagnostic value for PJI.

Results

Studies evaluating perioperative presepsin trends in primary TJA demonstrated that its natural course is similar to C-Reactive Protein (CRP). The area under (AUC) the receiver operating characteristic curves values for serum presepsin ranged from 0.86 to 0.926. These values were higher than the AUCs for CRP in each of their respective studies. However, synovial presepsin demonstrated a lower AUC (0.41). Prognostically, presepsin demonstrated potential in terms of infection monitoring following revision TJA for PJI.

Conclusion

Although the data remains limited, presepsin may serve as a potential biomarker to evaluate the natural inflammatory response following TJA as well as to help diagnose PJI. The present review serves to set the foundation for future study into serum presepsin in larger patient cohorts. Further study is needed to evaluate how this biomarker compares to other laboratory values traditionally used for PJI diagnosis.

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Authors and Affiliations

  1. School of Medicine, Case Western Reserve University, Health Education Campus, 9501 Euclid Avenue, Cleveland, OH, 44106, USA

    Mona Lisa Delva & Alexander J. Acuña

  2. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail code A40, Cleveland, OH, 44195, USA

    Linsen T. Samuel, Alexander J. Acuña & Atul F. Kamath

  3. Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail code A40, Cleveland, OH, 44195, USA

    Atul F. Kamath

Authors
  1. Mona Lisa Delva
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  2. Linsen T. Samuel
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  3. Alexander J. Acuña
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  4. Atul F. Kamath
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Corresponding author

Correspondence to Atul F. Kamath.

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Conflict of interest

A.F.K. reports the following disclosures: research support (Signature Orthopaedics), paid presenter or speaker (DePuy Synthes and Zimmer Biomet), paid consultant (DePuy Synthes and Zimmer Biomet), stock or stock options (Zimmer Biomet, Johnson & Johnson, and Procter & Gamble), IP royalties (Innomed), and board or committee member (AAOS, AAHKS, and Anterior Hip Foundation). M.L.D., A.J.A., and L.T.S. have nothing to disclose.

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Delva, M.L., Samuel, L.T., Acuña, A.J. et al. Presepsin as a diagnostic biomarker of peri-prosthetic joint infection: a review of the literature. Eur J Orthop Surg Traumatol 33, 695–700 (2023). https://doi.org/10.1007/s00590-022-03232-z

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  • DOI: https://doi.org/10.1007/s00590-022-03232-z

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