C-Reactive Protein-to-Albumin Ratio (CAR) and C-Reactive Protein-to-Lymphocyte Ratio (CLR) are Valuable Inflammatory Biomarker Combination for the Accurate Prediction of Periprosthetic Joint Infection

Weipeng Shi; Yaping Jiang; Hua Tian; Yingzhen Wang; Yingze Zhang; Tengbo Yu; Tao Li

doi:10.2147/IDR.S398958

C-Reactive Protein-to-Albumin Ratio (CAR) and C-Reactive Protein-to-Lymphocyte Ratio (CLR) are Valuable Inflammatory Biomarker Combination for the Accurate Prediction of Periprosthetic Joint Infection

Infect Drug Resist. 2023 Jan 25:16:477-486. doi: 10.2147/IDR.S398958. eCollection 2023.

Authors

Weipeng Shi^{1

2}, Yaping Jiang³, Hua Tian⁴, Yingzhen Wang¹, Yingze Zhang⁵, Tengbo Yu¹, Tao Li¹

Affiliations

¹ Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
² Medical Department of Qingdao University, Qingdao, Shandong, People's Republic of China.
³ Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
⁴ Department of Neurological Rehabilitation, Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao, People's Republic of China.
⁵ Key Laboratory of Biomechanics of Hebei Province, Department of Trauma Emergency Center, The Third Hospital of Hebei Medical University, Orthopaedics Research Institution of Hebei Province, Shijiazhuang, People's Republic of China.

Abstract

Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty (TJA). Timely and accurate diagnosis is important for the management of PJI. Currently, many biomarkers are available for the diagnosis of PJI, but which inflammatory biomarker combination has the best diagnostic value has not been reported.

Materials and methods: We retrospectively analyzed 244 patients who underwent revision knee or hip arthroplasty in our institution. They were divided into two groups: 87 in the PJI group and 157 in the aseptic failure (AF) group. The preoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP-to-albumin ratio (CAR), CRP-to-lymphocyte ratio (CLR), neutrophil-to-albumin ratio (NAR) and platelet-to-albumin ratio (PAR) were determined and compared between the two groups. Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to assess the diagnostic value of all biomarkers, and the optimal cut-off value, positive predictive value (PPV) and negative predictive value (NPV) were further calculated by the Youden index.

Results: The NLR, PLR, CAR, CLR, NAR and PAR of the PJI group were significantly higher than those of the AF group (P<0.001). According to the ROC and AUC results, the diagnostic value of CAR and CLR was considered excellent with AUCs of 0.931 and 0.935, respectively. The diagnostic value of NAR (0.739) and PAR (0.785) were fair, the diagnostic value of NLR (0.694) was poor, and PLR (0.535) had no diagnostic ability. Subgroup analysis showed no significant differences in combined inflammatory biomarkers between the two groups.

Conclusion: CAR and CLR are valuable combined inflammatory biomarkers for diagnosing PJI, while other markers were of limited value for the diagnosis of PJI.

Keywords: C-reactive protein-to-albumin ratio; C-reactive protein-to-lymphocyte ratio; biomarkers; periprosthetic joint infection.

Grants and funding

Qingdao Traditional Chinese Medicine Science and Technology Project; Grant number: 2021-zyym28; Science and technology Development Project of Shandong Geriatric Society; Grant number: LKJGG2021W082; Youth Research Foundation of Affiliated Hospital of Qingdao University; Grant number: QDFYQN202001012.