Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan;144(1):297-305.
doi: 10.1007/s00402-023-05052-0. Epub 2023 Oct 24.

Neutrophil-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis

Daniel Timothy Burchette  1   2 , Mustafa Fatih Dasci  3   4 , Beatriz Fernandez Maza  3   5 , Philip Linke  3 , Thorsten Gehrke  3 , Mustafa Citak  3
Affiliations

Neutrophil-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis

Daniel Timothy Burchette et al. Arch Orthop Trauma Surg. 2024 Jan.

Abstract

Purpose: To investigate reported correlations between Neutrophil-to-Lymphocyte (NLR) and Lymphocyte-to-Monocyte (LMR) ratios and their value in diagnosis of chronic prosthetic joint infection (PJI) in a large cohort of patients from a single specialist hospital.

Methods: Diagnostic aspirations of 362 patients under investigation for PJI were identified. Of the included patients 185 patients received a final diagnosis of PJI and 177 were classed as aseptic. Established criteria (ICM 2018) were employed to define PJI. Included in the analysis are differential white cell counts, C-Reactive Protein (CRP), Synovial Leukocyte Count, Synovial Alpha-defensin ELISA and Synovial Leukocyte esterase activity. Receiver-operator characteristic (ROC) curves were calculated for each of the available diagnostic tests together with the corresponding area under the curve values (AUC). Youden's index was utilized to identify the optimal diagnostic threshold point for the NLR and LMR. Other diagnostic tests were evaluated as per the threshold values previously defined in the literature and specified in the ICM criteria.

Results: Using Youden's Index to identify the optimal NLR cut-off within our cohort we established a value of 2.93. This yielded a sensitivity of 0.60 and specificity of 0.64. The area under the curve (AUC) of a receiving operator characteristics (ROC) curve was 0.625. Regarding the LMR the results demonstrate similar findings; a positive correlation with a diagnosis of infection but poor sensitivity and specificity. The AUC for LMR was 0.633 and was not superior to NLR (P = 0.753).

Conclusions: There is a significant correlation between higher Neutrophil-Lymphocyte and Lymphocyte-Monocyte ratios, and a diagnosis of PJI. The sensitivity and specificity of this calculation is poor and the does not add value to the diagnostic algorithm for PJI.

Level of evidence: Level III Retrospective Cohort analysis.

Keywords: Lymphocyte–monocyte ratio; Neutrophil–lymphocyte ratio; Periprosthetic joint infection.

PubMed Disclaimer

References

    1. AAOS Diagnosis and prevention of periprosthetic joint infecctions: Clinical practice guideline.
    1. Delcea C, Buzea CA, Dan GA (2019) The neutrophil to lymphocyte ratio in heart failure: a comprehensive review. Rom J Intern Med 57(4):296–314. https://doi.org/10.2478/rjim-2019-0018 - DOI - PubMed
    1. Festa E, Ascione T, Bernasconi A et al (2022) Diagnostic performance of neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio, and platelet to mean platelet volume ratio in periprosthetic hip and knee infections: a systematic review and meta-analysis. Diagnostics (Basel). https://doi.org/10.3390/diagnostics12092033 - DOI - PubMed
    1. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M (2017) What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 10(1):12. https://doi.org/10.1186/s13104-016-2335-5 - DOI - PubMed - PMC
    1. Gehrke T, Zahar A, Kendoff D (2013) One-stage exchange: it all began here. Bone Joint J 95-B(11 Suppl A):77–83 doi: https://doi.org/10.1302/0301-620X.95B11.32646

LinkOut - more resources