Abstract: OBJECTIVE: As one of the serious complications after total hip arthroplasty or total knee arthroplasty, periprosthetic joint infection has always been the focus of joint surgeons. Albumin/globulin ratio is emerging as a promising biomarker for the diagnosis of periprosthetic joint infection. This study aimed to investigate the diagnostic value of albumin/globulin ratio in diagnosing periprosthetic joint infection.
METHODS: A systematic search was conducted in PubMed, Embase, and Cochrane Library databases on July 29, 2023. The literature was screened according to the inclusion and exclusion criteria, and the literature related to diagnostic trials of albumin/globulin ratio was included in this study. QUADAS-2 method was used to evaluate the quality of the included articles. Bivariate mixed-effect model was applied to combine the sensitivity, specificity, likelihood ratio, and diagnostic odds ratio of the included articles, and the receiver operating characteristic curve and area under the curve were integrated to specifically evaluate the accuracy of D-dimer in the diagnosis of periprosthetic joint infection. Subgroup analysis was used to explore the sources of heterogeneity.
RESULTS: We included eight eligible diagnostic studies, all of which were of medium to high quality. The sensitivity and specificity of the combined diagnosis were 0.78 (95%CI: 0.66-0.86) and 0.83 (95%CI: 0.78-0.88), respectively. The combined positive and negative likelihood ratios were 4.63 (95%CI: 3.43-6.22) and 0.27 (95%CI: 0.17-0.42), respectively. The combined diagnostic scores and diagnostic odds ratio were 2.85 (95%CI: 2.23-3.48) and 17.35 (95%CI: 9.29-32.45), respectively. The area under the summary receiver operating characteristic curve was 0.88 (95%CI: 0.85-0.90).
CONCLUSION: The albumin/globulin ratio is of guiding significance in the diagnosis of periprosthetic joint infection. However, it is not universal in clinical practice, so it should be combined with specific clinical practice. In addition, there are relatively few studies on the threshold of albumin/globulin ratio, different sampling types, different laboratory detection methods, and different races, so more prospective clinical trials with large samples, multi-centers, and scientific design should be carried out for verification in the future.

Key words: albumin, globulin, albumin/globulin, hip, knee, arthroplasty, periprosthetic infection, inflammatory indicator, diagnostic trial, meta-analysis