Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (30): 4795-4801.doi: 10.3969/j.issn.2095-4344.2836
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Platelet count as a novel potential predictor of periprosthetic joint infection
Cao Houran1, Deng Peng2, Ye Pengcheng2, Jie Ke1, Zeng Jianchun2, Feng Wenjun2, Chen Jinlun2, Qi Xinyu1, Li Jie2, Tan Xueqiu1, Zhang Haitao1, Zeng Yirong2
- 1First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 2First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
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Received:2020-01-07Revised:2020-01-16Accepted:2020-03-04Online:2020-10-28Published:2020-09-19 -
Contact:Zeng Yirong, MD, Chief physician, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China -
About author:Cao Houran, Master candidate, First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China -
Supported by:the Moral Education Program of Innovation and Strong Academy Project of First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 2019IIT35
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Cao Houran, Deng Peng, Ye Pengcheng, Jie Ke, Zeng Jianchun, Feng Wenjun, Chen Jinlun, Qi Xinyu, Li Jie, Tan Xueqiu, Zhang Haitao, Zeng Yirong. Platelet count as a novel potential predictor of periprosthetic joint infection[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30): 4795-4801.
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The study was approved by the Institutional Review Board of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (approval No. 2019205). This single-center, retrospective, cohort study enrolled patients who underwent revision arthroplasty because of delayed or chronic infection of joint arthroplasties and aseptic loosening of an implant from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. PJI was diagnosed based on the MSIS criteria noted in Table 1[20]. Patients were excluded if they had hematological disease or underwent a blood transfusion within the last year, used ongoing antiplatelet drugs, had a history of recent trauma or dislocation (within 2 weeks), used lipid emulsion, associated with hepatic disease or other site infections. "
A total of 214 patients were recruited for the final analysis. Based on the MSIS criteria, 77 patients were classified into the PJI group (129 hips and 8 knees), while 137 patients were classified into the aseptic loosening group. The mean age in the PJI group was 60.6±13.1 years (range, 21-80 years); of them, 30 were men and 47 were women. The mean age in the aseptic loosening group was 64.0±11.7 years (range, 30-86 years); of them, 64 were men and 73 were women. No significant intergroup differences were detected in gender or age (P > 0.05). The characteristics of the enrolled patients are shown in Table 2. "
Serum PLT was significantly higher in the PJI group (330.36 ± 91.25 × 109/L) than in the aseptic loosening group (238.67 ± 60.82 × 109/L) (P < 0.001). WBC, ESR, and CRP values were also significantly higher among patients with PJI (P < 0.05). The mean MPV was also significantly higher in the PJI group than in the aseptic loosening group (P < 0.001). No significant intergroup differences were detected in the PDW values (P > 0.05; Table 3). "
The ROC curves showed that ESR had the highest AUC (0.829), followed by CRP (0.820), and PLT (0.804). The AUCs of these three markers were all between 0.8 and 0.9, indicating good diagnostic value for PJI. In contrast, MPV had an AUC of 0.695, which was the second lowest value but slightly higher than the AUC of WBC (0.619). The AUCs of these two markers were both lower than 0.7, indicating poor diagnostic value (Figure 1). "
The serum PLT demonstrated a sensitivity of 64.94% and a specificity of 85.40% for diagnosing PJI. Using Youden’s index, the optimal cutoff value for PLT was 300 × 109/L, which resulted in a good PPV and NPV of 69.56% and 81.56%, respectively. Based on the ROC analysis, when WBC was above 7.62 × 109/L, the sensitivity, specificity, PPV, and NPV were 55.84%, 67.88%, 48.86%, and 73.02%, respectively. Using a cutoff value for ESR of 31 mm/h, the sensitivity, specificity, PPV, and NPV were 77.92%, 75.91%, 63.83%, and 85.83%; using a cutoff value for CRP at 10.9 mg/L, the sensitivity, specificity, PPV, and NPV were 79.22%, 75.91%, 64.21%, and 86.55%, respectively. For MPV, the optimal cutoff value was 8.4%, resulting in sensitivity, speci?city, PPV, and NPV of 48.05%, 83.94%, 62.71%, and 74.19%, respectively (Table 4). "
Further analyses of the combined diagnostic value of PLT, WBC, ESR, and CRP were performed to improve their diagnostic accuracies. The combination of serum PLT and WBC/ESR improved the specificity and specificity (Table 5). PLT combined with the CRP improved the specificity but decreased the sensitivity. Promising AUC values indicating good diagnostic accuracy were obtained for the combinations of PLT and WBC (AUC = 0.805), PLT and CRP (AUC = 0.865), PLT and ESR (AUC = 0.880), ESR and CRP (AUC = 0.845), and ESR and WBC (AUC = 0.837) (Figure 2). Among them, the combined analysis of PLT and ESR had the highest AUC. The sensitivity, specificity, and AUC were 84.42%, 79.96%, and 0.880 (95%CI, 0.829-0.920). "
Further analyses of the combined diagnostic value of PLT, WBC, ESR, and CRP were performed to improve their diagnostic accuracies. The combination of serum PLT and WBC/ESR improved the specificity and specificity (Table 5). PLT combined with the CRP improved the specificity but decreased the sensitivity. Promising AUC values indicating good diagnostic accuracy were obtained for the combinations of PLT and WBC (AUC = 0.805), PLT and CRP (AUC = 0.865), PLT and ESR (AUC = 0.880), ESR and CRP (AUC = 0.845), and ESR and WBC (AUC = 0.837) (Figure 2). Among them, the combined analysis of PLT and ESR had the highest AUC. The sensitivity, specificity, and AUC were 84.42%, 79.96%, and 0.880 (95%CI, 0.829-0.920). "
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