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. 2025 Jul 8:15:1597401.
doi: 10.3389/fcimb.2025.1597401. eCollection 2025.

The role of ratio markers based on prealbumin in the diagnosis of periprosthetic joint infection

Qianqian Cao  1 , Xinchuang Ning  2 , Panlong Fan  1 , Tianmiao Cheng  3 , Yuzhe Zhang  4 , Cheng Cheng  1 , Zhipeng Dai  1
Affiliations

The role of ratio markers based on prealbumin in the diagnosis of periprosthetic joint infection

Qianqian Cao et al. Front Cell Infect Microbiol. .

Abstract

Background: Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty, and the timeliness of its diagnosis and treatment is crucial for patient recovery. Although various biomarkers have been extensively evaluated and applied in clinical practice, the diagnosis of PJI remains challenging. Therefore, it is necessary to identify more precise biomarkers for the diagnosis of PJI. This study aims to investigate the value of ratio-based biomarkers using prealbumin (PA) for the diagnosis of PJI.

Methods: This study compared the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen (FIB), PA, CRP/PA (CPR), ESR/PA (EPR), FIB/PA (FPR), and the combined ratio of CPR+EPR+FPR(CEF) in 180 patients with PJI and 105 patients with aseptic loosening (AL) who presented at our department from January 2019 to December 2024. The diagnostic efficacy of these markers in PJI diagnosis was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.

Results: Among these biomarkers, CPR has the highest AUC of 0.921 (95%CI 0.890-0.952), and it can distinguish PJI with a cut-off value of 0.0366, a sensitivity of 76.1%, and a specificity of 95.2%. In the diabetic subgroup, the combined biomarker CEF has an AUC of 0.951 for diagnosing PJI, with a sensitivity of 88.9% and a specificity of 94.4%.

Conclusion: Ratio-based markers based on PA show promise as valuable new adjunctive diagnostic markers for PJI.

Keywords: aseptic loosening; diabetes; marker; periprosthetic joint infection; prealbumin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient inclusion.
Figure 2
Figure 2
Comparison of levels of different markers between the PJI group and the AL group. Statistical significance: ***P<0.001. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FIB, fibrinogen; PA, prealbumin; CPR, CRP/PA; EPR, ESR/PA; FPR, FIB/PA; CEF, CPR+EPR+FPR.
Figure 3
Figure 3
The ROC curves of CRP, ESR, FIB, PA, CPR, EPR, FPR, and CEF. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FIB, fibrinogen; PA, prealbumin; CPR, CRP/PA; EPR, ESR/PA; FPR, FIB/PA; CEF, CPR+EPR+FPR.
Figure 4
Figure 4
Among the diabetes subgroups, the levels of different markers in the PJI group and the AL group. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FIB, fibrinogen; PA, prealbumin; CPR, CRP/PA; EPR, ESR/PA; FPR, FIB/PA; CEF, CPR+EPR+FPR. Statistical significance: ***P<0.001.
Figure 5
Figure 5
The ROC curves of CRP, ESR, FIB, PA, CPR, EPR, FPR, and CEF in the diabetes subgroups. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FIB, fibrinogen; PA, prealbumin; CPR, CRP/PA; EPR, ESR/PA; FPR, FIB/PA; CEF, CPR+EPR+FPR.
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