Synovial fluid presepsin as a novel biomarker for the rapid differential diagnosis of native joint septic arthritis from crystal arthritis

• Published in: International journal of infectious diseases Vol. 102; pp. 472 - 477
• Main Authors: Imagama, Takashi, Seki, Kazushige, Seki, Toshihiro, Tokushige, Atsunori, Matsuki, Yuta, Yamazaki, Kazuhiro, Nakashima, Daisuke, Okazaki, Tomoya, Hirata, Kenji, Yamamoto, Manabu, Tanaka, Hiroshi, Sakai, Takashi
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01-01-2021; Elsevier
• Subjects: Aged; Aged, 80 and over; Arthritis, Infectious - diagnosis; Arthritis, Infectious - metabolism; Arthritis, Infectious - therapy; Arthrocentesis; Biomarkers - analysis; C-Reactive Protein - analysis; Cross-Sectional Studies; Crystal arthritis; Crystal Arthropathies - diagnosis; Crystal Arthropathies - metabolism; Crystal Arthropathies - therapy; Diagnosis, Differential; Differential diagnosis; Early Diagnosis; Female; Humans; Lipopolysaccharide Receptors - analysis; Male; Native joint septic arthritis; Peptide Fragments - analysis; Presepsin; Procalcitonin - analysis; ROC Curve; Sensitivity and Specificity; Synovial fluid; Synovial Fluid - metabolism; Synovial fluid; Presepsin; Differential diagnosis; Crystal arthritis; Native joint septic arthritis
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.10.030

•The early differential diagnosis of native joint septic arthritis from crystal arthritis is often difficult.•Synovial fluid presepsin is highly sensitive and specific for native joint septic arthritis compared with blood presepsin, C-reactive protein, and procalcitonin.•Synovial fluid presepsin could be used as a novel biomarker for rapidly diagnosing and differentiating native joint septic arthritis from crystal arthritis.
To investigate whether presepsin can be used as a novel biomarker to differentiate between native joint septic arthritis (NJSA) and crystal arthritis (CA).
This study included 75 patients diagnosed with either NJSA (n = 21) or CA (n = 54). Presepsin in synovial fluid and blood, C-reactive protein, and procalcitonin were measured and compared between the NJSA and CA groups. Receiver operating characteristic (ROC) curve analyses were performed to differentiate between the two groups.
Synovial fluid and blood presepsin were significantly higher in the NJSA group than in the CA group (p < 0.0001 and p < 0.01, respectively). The area under the ROC curve for synovial fluid presepsin in the NJSA group compared with the CA group was 0.93 (sensitivity 85.7%, specificity 85.2%, positive predictive value 69.2%, negative predictive value 93.9%, positive likelihood ratio 5.79, negative likelihood ratio 0.17). Among the tests, synovial fluid presepsin was the most accurate.
Measurement of synovial fluid presepsin is reliable for the early diagnosis of NJSA, and synovial fluid presepsin could be used as a novel biomarker for differentiating between NJSA and CA.