Yu-Qing Zeng1,2, Shu Deng3, Xing-Yang Zhu1, Xiao-Bo Sun1, Wen-Jun Feng4, Jian-Chun Zeng4, Hai-Tao Zhang1, Yi-Rong Zeng4. 1. The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China. 2. Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China. 3. Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China. 4. Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Abstract
OBJECTIVES: There is a controversy on the diagnostic reliability and accuracy of synovial fluid α-defensin in periprosthetic joint infection (PJI). We performed this meta-analysis to evaluate the diagnostic accuracy of the α-defensin lateral flow test in PJI. METHODS: PubMed, Embase, and the Cochrane library were systematically searched, and articles (up to January 2020) on the diagnosis of hip and knee PJIs using the α-defensin Synovasure lateral flow test were included. The diagnostic accuracy of the α-defensin lateral flow test in PJI was evaluated using meta-analysis. The pooled sensitivity, specificity, accuracy, positive and negative likelihood ratio, diagnostic odds ratio, and post-test probabilities were calculated. RESULTS: Seventeen studies including 1443 cases were included. Meta-analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and a diagnostic odds ratio was 0.83 (95% CI 0.77, 0.88), 0.95 (95% CI 0.93, 0.97), 16.86 (95% CI 11.67, 24.37), 0.17 (95% CI 0.13, 0.24) and 85.30 (95% CI 47.76, 152.35), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97 (95% CI 0.95, 0.98). Subgroup analysis also confirmed the high efficiency of α-defensin Synovasure lateral flow test in diagnosing PJIs, irrespective of ethnicity. Fagan's nomogram analysis there was a high positive post-test probability of 94% and a low negative post-test probability of 15%. CONCLUSIONS: We indicated that the α-defensin lateral flow test had a high accuracy for diagnosing PJI. Large-scale studies are needed to validate its significance in PJI diagnosis.
OBJECTIVES: There is a controversy on the diagnostic reliability and accuracy of synovial fluid α-defensin in periprosthetic joint infection (PJI). We performed this meta-analysis to evaluate the diagnostic accuracy of the α-defensin lateral flow test in PJI. METHODS: PubMed, Embase, and the Cochrane library were systematically searched, and articles (up to January 2020) on the diagnosis of hip and knee PJIs using the α-defensin Synovasure lateral flow test were included. The diagnostic accuracy of the α-defensin lateral flow test in PJI was evaluated using meta-analysis. The pooled sensitivity, specificity, accuracy, positive and negative likelihood ratio, diagnostic odds ratio, and post-test probabilities were calculated. RESULTS: Seventeen studies including 1443 cases were included. Meta-analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and a diagnostic odds ratio was 0.83 (95% CI 0.77, 0.88), 0.95 (95% CI 0.93, 0.97), 16.86 (95% CI 11.67, 24.37), 0.17 (95% CI 0.13, 0.24) and 85.30 (95% CI 47.76, 152.35), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97 (95% CI 0.95, 0.98). Subgroup analysis also confirmed the high efficiency of α-defensin Synovasure lateral flow test in diagnosing PJIs, irrespective of ethnicity. Fagan's nomogram analysis there was a high positive post-test probability of 94% and a low negative post-test probability of 15%. CONCLUSIONS: We indicated that the α-defensin lateral flow test had a high accuracy for diagnosing PJI. Large-scale studies are needed to validate its significance in PJI diagnosis.
Authors: Steven B Soliman; Jason J Davis; Stephanie J Muh; Saifuddin T Vohra; Ashish Patel; Marnix T van Holsbeeck Journal: Skeletal Radiol Date: 2022-05-28 Impact factor: 2.128
Authors: Stuart Irwin; Brett Wagner Mackenzie; Brya G Matthews; Dustin L Williams; Jillian Cornish; Simon Swift Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2021-11-04