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. 2018 Jul 27;3(3):156-164.
doi: 10.7150/jbji.26401. eCollection 2018.

Qualitative Alpha-defensin Versus The Main Available Tests For The Diagnosis Of Periprosthetic Joint Infection: Best Predictor Test?

Giovanni Riccio  1 , Luca Cavagnaro  2 , Wassim Akkouche  3 , Giuliana Carrega  1 , Lamberto Felli  2 , Giorgio Burastero  4
Affiliations

Qualitative Alpha-defensin Versus The Main Available Tests For The Diagnosis Of Periprosthetic Joint Infection: Best Predictor Test?

Giovanni Riccio et al. J Bone Jt Infect. .

Abstract

Introduction: Biomarkers such as α-defensin demonstrated to be a potentially useful option in periprosthetic joint infection (PJI) diagnosis. Recently, a new point-of-care test for α-defensin level detection in synovial fluid has been commercialized in Europe. The aim of this study is to compare the α-defensin test (SynovasureTM) diagnostic ability with the main available clinical tests for periprosthetic joint infection diagnosis in a practical clinical setting of a Bone Infection Unit. Methods: Between 2015 and 2017, 146 patients with suspected chronic PJI were screened with SynovasureTM. Seventy-three of these met the Musculoskeletal Infection Society (MSIS) criteria and were included in the analysis. According to MSIS criteria, 40 patients (54.7%) were classified as infected and 33 (45.3%) as not infected. The results obtained with SynovasureTM were recorded and compared with standard diagnostic methods for PJI diagnosis. Results: SynovasureTM showed a sensitivity of 85.0 % (95% CI 70.2 to 94.3) and a specificity of 96.9 % (95% CI 83.8 to 99.9) for PJI detection. The positive likelihood ratio of SynovasureTM was 27.2 (95% CI 3.9 to 188.1) and the negative likelihood ratio was 0.2 (95% CI 0.1 to 0.3). The diagnostic odds ratio was 181.3 (95% CI 20.7 to 1590.4). SynovasureTM demonstrated a statistical significant difference when compared to Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) specificity (at least one positive test) and preoperative culture sensitivity (1 positive culture). Conclusion: Our findings show that SynovasureTM sensitivity is lower than quantitative α-D test, but when compared to the main available tests shows a good specificity and the highest DOR. On the SF it is the easier test to do, due to the fact that it needs a minimal amount of SF and it is not limited by blood contamination or antibiotic use. Whereas there is no single standalone test, SynovasureTM should be considered a reliable additional test for periprosthetic joint infection diagnosis in everyday clinical practice.

Keywords: Alpha-defensin; Periprosthetic joint infection; Synovasure; Synovial fluid.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
The figure shows the number of patients screened for each test. The striped column represents the total number of patients included in the study.
See this image and copyright information in PMC

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