Serum C-reactive protein relationship in high- versus low-virulence pathogens in the diagnosis of periprosthetic joint infection

Abstract

Little is known about the relationship between the virulence of pathogens in periprosthetic joint infection (PJI) and C-reactive protein (CRP) levels. In this context, we assessed the performance of CRP for PJI. We collected the following data from 987 cases of total joint revision due to PJI and 386 cases of aseptic revision: age, gender, comorbidities, values for serum CRP, leukocytes, microbiology for preoperatively taken aspirations and at least 2 intraoperative biopsies, and presence or absence of a draining sinus. The mean CRP value in the PJI group was 50.2 mg l^-1 (sd=62.2), while a lower CRP value of 11.6 mg l^-1 (sd=25.3) was found in the control group. There were no significant differences for the CRP values between patients with and without draining sinus (P=0.4423). The difference in CRP between high-virulence and low-virulence micro-organisms was significant for both the hip and the knee (P<0.0001). For the hip, the area under the receiver operating characteristic curve (AUC) of CRP as a diagnostic marker for PJI was 0.830 and, for the knee, the AUC was 0.884. The optimal cutoff point for CRP as a diagnostic marker of PJI, calculated using Youden's index, was 8.90 mg l^-1 for the hip and 9.99 mg l^-1 for the knee. The study results add valuable new information regarding the organism profile that may help with the diagnostic workup and with the research and development of new strategies for diagnosing and treating PJI.

Keywords: CRP; diagnostic organism profile; high virulence; low virulence; periprosthetic joint infection; virulence.