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Diagnostic accuracy of alpha-defensin in periprosthetic joint infection: a systematic review and meta-analysis

Authors
  • Yuan, Jun1, 2
  • Yan, Yufei1, 2
  • Zhang, Jiong1, 2
  • Wang, Bibo1, 2
  • Feng, Jianmin1, 2
  • 1 Shanghai Jiao Tong University School of Medicine, Department of Orthopaedics, Ruijin Hospital, 197 Ruijin 2nd Road, Shanghai, 200025, People’s Republic of China , Shanghai (China)
  • 2 Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, 197 Ruijin 2nd Road, Shanghai, 200025, People’s Republic of China , Shanghai (China)
Type
Published Article
Journal
International Orthopaedics
Publisher
Springer-Verlag
Publication Date
Sep 30, 2017
Volume
41
Issue
12
Pages
2447–2455
Identifiers
DOI: 10.1007/s00264-017-3647-3
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundAlpha-defensin, a novel biomarker, has shown great potential for the accurate diagnosis of periprosthetic joint infection (PJI) in recent years: many published studies have presented encouraging results. Nevertheless, the diagnostic accuracy of alpha-defensin is inconsistent across published studies. Moreover, the optimum value of the diagnostic threshold urgently needs to be ascertained. This meta-analysis sought to estimate the precision of alpha-defensin for the diagnosis of PJI and, where possible, to confirm the threshold.MethodWe systematically searched PubMed, Embase, Cochrane, Web of Knowledge, and ClinicalTrials.gov for relevant literature on alpha-defensin in the diagnosis of PJI (searching publications from the inception of each database until February 2017, with no language restriction). Pooled sensitivity, specificity, diagnostic odds ratios, and likelihood ratios were the indexes used for assessment, with the use of a random-effects model.ResultEleven of the 426 studies that evaluated the diagnostic accuracy of alpha-defensin in periprosthetic joint infection (PJI) were included in this analysis. The pooled diagnostic sensitivity of alpha-defensin for PJI was 0.96 (95% confidence interval [CI], 0.87 to 0.99) and the specificity was 0.95 (95% CI, 0.91 to 0.97). Since there was substantial heterogeneity among studies, based on the inconsistency index (I2), threshold, site of arthroplasty, study design and techniques for the alpha-defensin test, subgroup analyses were performed to estimate the impacts of these variables on heterogeneity.ConclusionIn summary, this meta-analysis clearly lends support to the conclusion that alpha-defensin is a promising addition to the current methods for diagnosis of PJI.

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