title: Interleukin-6 in two-stage revision arthroplasty: what is the threshold value to exclude persistent infection before re-implanatation?
abstract: The purpose of this study was to evaluate whether the serum level of interleukin 6 (IL-6) could be used to identify the persistence of infection after the first stage of a two-stage revision for periprosthetic joint infection. Between 2010 and 2011, we prospectively studied 55 patients (23 men, 32 women; mean age 69.5 years; 36 to 86) with a periprosthetic joint infection. Bacteria were identified in two intra-operative tissue samples during re-implantation in 16 patients. These cases were classified as representing persistent infection. To calculate a precise cut-off value which could be used in everyday clinical practice, a 3 x 2 contingency table was constructed and manually defined. We found that a serum IL-6 ≥ 13 pg/mL can be regarded as indicating infection: its positive-predictive value is 90.9%. A serum IL-6 ≤ 8 pg/mL can be regarded as indicating an absence of infection: its negative predictive value is 92.1%. The serum IL-6 level seems to be a reasonable marker for identifying persistent infection after the first stage of a revision joint arthroplasty and before attempting re-implantation.
authors.affiliation: Department of General and Tumor Orthopedics, Center of Arthroplasty and Revision Arthroplasty, University Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hoell
authors.affiliation: Department of General and Tumor Orthopedics, Center of Arthroplasty and Revision Arthroplasty, University Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Borgers
authors.affiliation: Department of General and Tumor Orthopedics, Center of Arthroplasty and Revision Arthroplasty, University Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Gosheger
authors.affiliation: Department of General and Tumor Orthopedics, Center of Arthroplasty and Revision Arthroplasty, University Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Dieckmann
authors.affiliation: Department of General and Tumor Orthopedics, Center of Arthroplasty and Revision Arthroplasty, University Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Schulz
authors.affiliation: Institute of Biostatistics and Clinical Research, University Hospital Muenster, Schmeddingstraße 56, 48149 Muenster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gerss
authors.affiliation: Department of General and Tumor Orthopedics, Center of Arthroplasty and Revision Arthroplasty, University Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hardes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D012372:ROC Curve; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015850:Interleukin-6
keywords: Antibiotic loaded spacer; IL 6; Replantation; Two stage revision arthroplasty; periprosthetic joint infection