Synovial Fluid d-Lactate-A Novel Pathogen-Specific Biomarker for the Diagnosis of Periprosthetic Joint Infection

Svetlana Karbysheva; Katsiaryna Yermak; Ludmila Grigoricheva; Nora Renz; Carsten Perka; Andrej Trampuz

doi:10.1016/j.arth.2020.03.016

Synovial Fluid d-Lactate-A Novel Pathogen-Specific Biomarker for the Diagnosis of Periprosthetic Joint Infection

J Arthroplasty. 2020 Aug;35(8):2223-2229.e2. doi: 10.1016/j.arth.2020.03.016. Epub 2020 Mar 16.

Authors

Svetlana Karbysheva¹, Katsiaryna Yermak², Ludmila Grigoricheva³, Nora Renz², Carsten Perka², Andrej Trampuz⁴

Affiliations

¹ Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Federal Center of Traumatology, Orthopedics and Arthroplasty, Barnaul, Russia; Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.
² Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany.
³ Federal Center of Traumatology, Orthopedics and Arthroplasty, Barnaul, Russia.
⁴ Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.

PMID: 32269008
DOI: 10.1016/j.arth.2020.03.016

Abstract

Background: Synovial fluid d-lactate may be useful for diagnosing periprosthetic joint infection (PJI) as this biomarker is exclusively produced by bacteria. We evaluated the performance of synovial fluid d-lactate using 2 definition criteria and determined its optimal cutoff value for diagnosing PJI.

Methods: Consecutive patients undergoing joint aspiration before prosthesis revision were prospectively included. Synovial fluid was collected for culture, leukocyte count, and d-lactate concentration (by spectrophotometry). Youden's J statistic was used for determining optimal d-lactate cutoff value on the receiver operating characteristic curve by maximizing sensitivity and specificity.

Results: A total of 224 patients were included. Using Musculoskeletal Infection Society criteria, 71 patients (32%) were diagnosed with PJI and 153 (68%) with aseptic failure (AF), whereas using institutional criteria, 92 patients (41%) were diagnosed with PJI and 132 (59%) with AF. The optimal cutoff of synovial fluid d-lactate to differentiate PJI from AF was 1.3 mmol/L, independent of the used definition criteria. Synovial fluid d-lactate had a sensitivity of 94.3% (95% confidence interval [95% CI], 86.2-98.4) and specificity of 78.4% (95% CI, 66.8-81.2) using Musculoskeletal Infection Society criteria, whereas its sensitivity was 92.4% (95% CI, 84.9-96.9) and specificity 88.6% (95% CI, 81.9-93.5) using institutional criteria. The concentration of d-lactate was higher in infections caused by Staphylococcus aureus (P < .001) and streptococci (P = .016) than by coagulase-negative staphylococci or in culture-negative PJI.

Conclusion: The synovial fluid d-lactate showed high sensitivity (>90%) for diagnosis of PJI using both definition criteria and correlated with the pathogen virulence. The high sensitivity makes this biomarker useful as a point-of-care screening test for PJI.

Level of evidence: Diagnostic level I.

Keywords: biomarker; d-lactate; diagnosis; periprosthetic joint infection; synovial fluid.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Hip*
Biomarkers
C-Reactive Protein / analysis
Humans
Lactic Acid
Prosthesis-Related Infections* / diagnosis
Prosthesis-Related Infections* / surgery
Reoperation
Sensitivity and Specificity
Synovial Fluid / chemistry

Substances

Biomarkers
Lactic Acid
C-Reactive Protein