Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool?
Abstract Background This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. Materials and methods Between January 2020 a...
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SpringerOpen
2025-07-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-025-00857-8 |
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| author | Domenico De Mauro Tiziana Ascione Enrico Festa Lucrezia Marasco Filippo Leggieri Sara Rosito Matteo Innocenti Edoardo Di Pace Giovanni Balato |
| author_facet | Domenico De Mauro Tiziana Ascione Enrico Festa Lucrezia Marasco Filippo Leggieri Sara Rosito Matteo Innocenti Edoardo Di Pace Giovanni Balato |
| author_sort | Domenico De Mauro |
| collection | DOAJ |
| description | Abstract Background This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. Materials and methods Between January 2020 and April 2022, patients with failed or painful knee arthroplasty who were admitted to a tertiary referral institution undergoing the standardized diagnostic protocol to identify those with a periprosthetic joint infection (PJI) were analyzed. The 2018 International Consensus Meeting (ICM) criteria were used to classify patients with PJIs and aseptic joints. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve (AUC) of AGR were calculated to define the test’s diagnostic accuracy. Results The ROC curve showed that the optimal cutoff value of AGR was 1.43. AGR registered a sensitivity of 95% (95% CI 91–197%), a specificity of 63% (95% CI 56–69%), a positive predictive value of 75% (95% CI 69–81%), and a negative predictive value of 91% (95% CI 86–94%). Receiver operator curve analysis demonstrated an AUC of 0.85 (95% CI 0.77–0.88). Although body mass index (BMI), uremia, glutamic-oxaloacetic transaminase (GOT), international normalized ratio (INR), and alkaline phosphatase showed significant differences between the false positive cases and those cases affected by aseptic failure with AGR higher than 1.43, indicating potential confounding effects (p < 0.05), no parameter was found to be a significant predictor of false positives cases (p > 0.05). Conclusions For its high sensitivity, AGR showed potential as a screening tool for detecting infections in PJI diagnostics. Level of evidence: III. |
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| id | doaj-art-fbaba1164769446d99c79c86feee87c1 |
| institution | Kabale University |
| issn | 1590-9999 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj-art-fbaba1164769446d99c79c86feee87c12025-08-20T03:45:36ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992025-07-012611810.1186/s10195-025-00857-8Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool?Domenico De Mauro0Tiziana Ascione1Enrico Festa2Lucrezia Marasco3Filippo Leggieri4Sara Rosito5Matteo Innocenti6Edoardo Di Pace7Giovanni Balato8Department of Public Health, Orthopedic Unit, “Federico II” UniversityDepartment of Infectious Diseases, Service of Infectious Diseases, AORN “Dei Colli” – Via Cardarelli, AORN A. Cardarelli HospitalDepartment of Public Health, Orthopedic Unit, “Federico II” UniversityDepartment of Public Health, Orthopedic Unit, “Federico II” UniversityDepartment of Clinical Orthopedics, Careggi University Hospital, University of FlorenceDepartment of Public Health, Orthopedic Unit, “Federico II” UniversityDepartment of Clinical Orthopedics, Careggi University Hospital, University of FlorenceDepartment of Public Health, Orthopedic Unit, “Federico II” UniversityDepartment of Public Health, Orthopedic Unit, “Federico II” UniversityAbstract Background This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. Materials and methods Between January 2020 and April 2022, patients with failed or painful knee arthroplasty who were admitted to a tertiary referral institution undergoing the standardized diagnostic protocol to identify those with a periprosthetic joint infection (PJI) were analyzed. The 2018 International Consensus Meeting (ICM) criteria were used to classify patients with PJIs and aseptic joints. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve (AUC) of AGR were calculated to define the test’s diagnostic accuracy. Results The ROC curve showed that the optimal cutoff value of AGR was 1.43. AGR registered a sensitivity of 95% (95% CI 91–197%), a specificity of 63% (95% CI 56–69%), a positive predictive value of 75% (95% CI 69–81%), and a negative predictive value of 91% (95% CI 86–94%). Receiver operator curve analysis demonstrated an AUC of 0.85 (95% CI 0.77–0.88). Although body mass index (BMI), uremia, glutamic-oxaloacetic transaminase (GOT), international normalized ratio (INR), and alkaline phosphatase showed significant differences between the false positive cases and those cases affected by aseptic failure with AGR higher than 1.43, indicating potential confounding effects (p < 0.05), no parameter was found to be a significant predictor of false positives cases (p > 0.05). Conclusions For its high sensitivity, AGR showed potential as a screening tool for detecting infections in PJI diagnostics. Level of evidence: III.https://doi.org/10.1186/s10195-025-00857-8PJIDiagnosticAlbuminGlobulinSerum markersTotal knee arthroplasty |
| spellingShingle | Domenico De Mauro Tiziana Ascione Enrico Festa Lucrezia Marasco Filippo Leggieri Sara Rosito Matteo Innocenti Edoardo Di Pace Giovanni Balato Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool? Journal of Orthopaedics and Traumatology PJI Diagnostic Albumin Globulin Serum markers Total knee arthroplasty |
| title | Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool? |
| title_full | Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool? |
| title_fullStr | Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool? |
| title_full_unstemmed | Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool? |
| title_short | Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool? |
| title_sort | diagnostic work up in periprosthetic joint infections of the knee can the albumin to globulin ratio be a screening tool |
| topic | PJI Diagnostic Albumin Globulin Serum markers Total knee arthroplasty |
| url | https://doi.org/10.1186/s10195-025-00857-8 |
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