title: Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement.
abstract: This prospective study evaluates the role of new laboratory markers in the diagnosis of deep implant infection in 78 patients (41 men and 37 women) with a revision total knee or hip replacement. The mean age at the time of operation was 64.0 years (19 to 90). Intra-operative cultures showed that 21 patients had a septic and 57 an aseptic total joint replacement. The white blood cell count, the erythrocyte sedimentation rate and levels of C-reactive protein, interleukin-6, procalcitonin and tumour necrosis factor (TNF)-alpha were measured in blood samples before operation. The diagnostic cut-off values were determined by Received Operating Characteristic curve analysis. C-reactive protein (> 3.2 md/dl) and interleukin-6 (> 12 pg/ml) have the highest sensitivity (0.95). Interleukin-6 is less specific than C-reactive protein (0.87 vs 0.96). Combining C-reactive protein and interleukin-6 identifies all patients with deep infection of the implant. Procalcitonin (> 0.3 ng/ml) and TNF-alpha (> 40 ng/ml) are very specific (0.98 vs 0.94) but have a low sensitivity (0.33 vs 0.43). The combination of C-reactive protein and interleukin-6 measurement provide excellent screening tests for infection of a deep implant. A highly specific marker such as procalcitonin and pre-operative aspiration of the joint might be useful in identifying patients with true positive C-reactive protein and/or interleukin-6 levels.
authors.affiliation: Hospital for Special Surgery, New York 10021, USA. DrBoettner@email.de
authors.forename: F
authors.initials: F
authors.lastname: Bottner
authors.forename: A
authors.initials: A
authors.lastname: Wegner
authors.forename: W
authors.initials: W
authors.lastname: Winkelmann
authors.forename: K
authors.initials: K
authors.lastname: Becker
authors.forename: M
authors.initials: M
authors.lastname: Erren
authors.forename: C
authors.initials: C
authors.lastname: Götze
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001424:Bacterial Infections / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004812:Epidemiologic Methods; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007720:Knee Prosthesis / Q000009:adverse effects*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology; D011498:Protein Precursors / Q000097:blood; D012086:Reoperation; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide