Are Red Blood Cell Distribution Width and Platelet Count Useful for Diagnosing Periprosthetic Joint Infection in Patients Undergoing Re-Revision Arthroplasty

Abstract

Objective: Accurate and prompt identification of periprosthetic joint infections (PJIs) is critical prior to re-revision arthroplasty to ensure optimal surgical outcomes. Among routinely measured blood indices, red blood cell distribution width (RDW) and platelet count (PLT) have shown strong correlations with infection presence. This study aimed to assess the utility of RDW and PLT for diagnosing PJI in patients scheduled for re-revision arthroplasty.

Methods: This retrospective research encompassed all patients who underwent re-revision hip or knee arthroplasty at our institution from 2008 to 2022. Participants were categorized into either the PJI (n = 41) or the non-PJI (n = 47) group following the guidelines established in the 2013 International Consensus Meeting on PJI. In this analysis, RDW and PLT counts were evaluated alongside conventional inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The efficacy of these diagnostics was evaluated by the area under the receiver operating characteristic (ROC) curve ([area under the curve AUC]).

Results: RDW demonstrated a modest AUC of 0.678 with sensitivity at 61.0% and specificity at 71.7%, using a threshold of 14.5%. PLT was on par with ESR, showing an AUC of 0.773, and both sensitivity and specificity around 73% at a threshold of 201 × 10⁹/L. CRP presented the highest diagnostic accuracy with an AUC of 0.815, achieving a sensitivity of 82.9% and specificity of 73.9% at a 6.9 mg/L threshold, surpassing ESR’s AUC of 0.754. None of the biomarkers, individually or combined, outperformed CRP alone (p > 0.05).

Conclusions: In the context of re-revision arthroplasty, RDW and PLT demonstrate limited efficacy as diagnostic biomarkers for PJI. However, CRP retains its reliability as a biomarker when the diagnostic threshold is appropriately recalibrated.

Keywords

Diagnosis / Periprosthetic Joint Infection / Platelet / Red Blood Cell Distribution Width / Re-revision Arthroplasty

References

[1] Xu H, Xie J, Wang D, Huang Q, Huang Z, Zhou Z. Plasma levels of D-dimer and fibrin degradation product are unreliable for diagnosing periprosthetic joint infection in patients undergoing re-revision arthroplasty. J Orthop Surg Res. 2021; 16(1): 628.

[2] Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4): 780–785.

[3] Fehring TK, Odum SM, Berend KR, Jiranek WA, Parvizi J, Bozic KJ, et al. Failure of irrigation and débridement for early postoperative periprosthetic infection. Clin Orthop Relat Res. 2013; 471(1): 250–257.

[4] Xu H, Xie JW, Liu L, Wang D, Huang ZY, Zhou ZK. Combination of CRP with NLR is a sensitive tool for screening fixation-related infection in patients undergoing conversion total hip arthroplasty after failed internal fixation for femoral neck fracture. Bone Joint J. 2021; 103-b(9): 1534–1540.

[5] Parvizi J, Gehrke T. Definition of Periprosthetic joint infection. J Arthroplasty. 2014; 29(7): 1331.

[6] Kanafani ZA, Sexton DJ, Pien BC, Varkey J, Basmania C, Kaye KS. Postoperative joint infections due to Propionibacterium species: a case-control study. Clin Infect Dis. 2009; 49(7): 1083–1085.

[7] Xu H, Xie J, Huang Q, Lei Y, Zhang S, Pei F. Plasma fibrin degradation product and D-dimer are of limited value for diagnosing Periprosthetic joint infection. J Arthroplasty. 2019; 34(10): 2454–2460.

[8] Huang YL, Hu ZD, Liu SJ, Sun Y, Qin Q, Qin BD, et al. Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies. PLoS One. 2014; 9(8): e104861.

[9] Evans TC, Jehle D. The red blood cell distribution width. J Emerg Med. 1991; 9(Suppl 1): 71–74.

[10] Aali-Rezaie A, Alijanipour P, Shohat N, Vahedi H, Foltz C, Parvizi J. Red cell distribution width: an unacknowledged predictor of mortality and adverse outcomes following revision arthroplasty. J Arthroplasty. 2018; 33(11): 3514–3519.

[11] Umman V, Gumus T, Kivratma HG, Tabatabayi P, Uguz A, Zeytunlu M, et al. Predictive value of red blood cell distribution width, platelet count to lymphocyte count ratio, and neutrophil count to lymphocyte count ratio values for the detection of postoperative infection in patients undergoing liver transplantation. Transplant Proc. 2023; 55(5): 1257–1261.

[12] Wu J, Zhang X, Liu H, Guo N, Pan Q, Wang Y. RDW, NLR and RLR in predicting liver failure and prognosis in patients with hepatitis E virus infection. Clin Biochem. 2019; 63: 24–31.

[13] Gautam I, Storad Z, Filipiak L, Huss C, Meikle CK, Worth RG, et al. From classical to unconventional: the immune receptors facilitating platelet responses to infection and inflammation. Biology (Basel). 2020; 9(10): 343.

[14] Gasparyan AY, Sandoo A, Stavropoulos-Kalinoglou A, Kitas GD. Mean platelet volume in patients with rheumatoid arthritis: the effect of anti-TNF-α therapy. Rheumatol Int. 2010; 30(8): 1125–1129.

[15] Ozcelik N, Ozyurt S, Yilmaz Kara B, Gumus A, Sahin U. The value of the platelet count and platelet indices in differentiation of COVID-19 and influenza pneumonia. J Med Virol. 2021; 93(4): 2221–2226.

[16] Xu H, Xie J, Yang J, Chen G, Huang Q, Pei F. Plasma fibrinogen and platelet count are referable tools for diagnosing Periprosthetic joint infection: a single-center retrospective cohort study. J Arthroplasty. 2020; 35(5): 1361–1367.

[17] Paziuk T, Rondon AJ, Goswami K, Tan TL, Parvizi J. A novel adjunct indicator of Periprosthetic joint infection: platelet count and mean platelet volume. J Arthroplasty. 2020; 35(3): 836–839.

[18] Chen MF, Chang CH, Chiang-Ni C, Hsieh PH, Shih HN, Ueng SWN, et al. Rapid analysis of bacterial composition in prosthetic joint infection by 16S rRNA metagenomic sequencing. Bone Joint Res. 2019; 8(8): 367–377.

[19] Zaaqoq AM, Namas RA, Abdul-Malak O, Almahmoud K, Barclay D, Yin J, et al. Diurnal variation in systemic acute inflammation and clinical outcomes following severe blunt trauma. Front Immunol. 2019; 10: 2699.

[20] Medcalf RL, Keragala CB, Draxler DF. Fibrinolysis and the immune response in trauma. Semin Thromb Hemost. 2020; 46(2): 176–182.

[21] Xu H, Zhou J, Huang Q, Huang Z, Xie J, Zhou Z. Unreliability of serum-or plasma-based assays of D-dimer or fibrin (fibrinogen) degradation product for diagnosing Periprosthetic joint infection: a prospective parallel study. Orthopaedic Surg. 2023; 16(1): 29–37.

[22] Xu H, Liu L, Xie J, Huang Q, Lai Y, Zhou Z. Plasma fibrinogen: a sensitive biomarker for the screening of periprosthetic joint infection in patients undergoing re-revision arthroplasty. BMC Musculoskelet Disord. 2022; 23(1): 520.

[23] Huang B, Yan J, Li C, Jin F, Ma R, Cao G, et al. Red blood cell distribution width is a risk factor for multiple organ dysfunction syndrome in elderly patients with infection: a case control study. Aging Clin Exp Res. 2023; 35(7): 1577–1580.

[24] Lee H, Kong SY, Sohn JY, Shim H, Youn HS, Lee S, et al. Elevated red blood cell distribution width as a simple prognostic factor in patients with symptomatic multiple myeloma. Biomed Res Int. 2014; 2014: 145619.

[25] Garcez ME, Peres W, Salvador M. Oxidative stress and hematologic and biochemical parameters in individuals with down syndrome. Mayo Clin Proc. 2005; 80(12): 1607–1611.

[26] Nan W, Li S, Wan J, Peng Z. Association of mean RDW values and changes in RDW with in-hospital mortality in ventilator-associated pneumonia (VAP): evidence from MIMIC-IV database. Int J Lab Hematol. 2023; 46(1): 99–106.

[27] Foy BH, Carlson JCT, Reinertsen E, Padros I, Valls R, Pallares Lopez R, et al. Association of red blood cell distribution width with mortality risk in hospitalized adults with SARS-CoV-2 infection. JAMA Netw Open. 2020; 3(9): e2022058.

[28] Portier I, Campbell RA. Role of platelets in detection and regulation of infection. Arterioscler Thromb Vasc Biol. 2021; 41(1): 70–78.

[29] Couldwell G, Machlus KR. Modulation of megakaryopoiesis and platelet production during inflammation. Thromb Res. 2019; 179: 114–120.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.