The impact of diabetes mellitus on biomarkers for the diagnosis of periprosthetic joint infection.

OBJECTIVE

The aim of this study is to explore the impact of diabetes on the diagnosis of periprosthetic joint infection (PJI) by evaluating the levels of biomarkers and their diagnostic efficacy.

METHODS

According to the diagnostic criteria for diabetes mellitus (DM), 394 patients were divided into the DM group (n=113) and the Non-DM group (n=281); each of these two groups was further subdivided into the PJI group and the aseptic loosening (AL) group based on the presence or absence of PJI. The levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen (FIB), D-dimer, CRP-albumin ratio (CAR), and CRP-FIB ratio (CFR) were collected from all patients. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of the aforementioned biomarkers under different glucose metabolism statuses.

RESULTS

In both the DM group and the Non-DM group, the levels of all biomarkers in patients with PJI were significantly higher than those in patients with AL (P<0.001). The CAR showed the highest diagnostic efficacy in both groups (AUC = 0.918 in the DM group and AUC = 0.931 in the Non-DM group). Notably, compared with the Non-DM group, the optimal cut-off values of CRP and ESR were elevated in the DM group (CRP: 9.960 mg/L vs 7.895 mg/L; ESR: 43.0 mm/h vs 36.5 mm/h).

CONCLUSION

Diabetes does not affect the biomarker levels in patients with PJI. However, for diabetic patients, the diagnostic thresholds of CRP and ESR are relatively higher. Thus, caution should be exercised in clinical diagnosis to avoid false positives. Among all indicators, the CAR demonstrates the best diagnostic efficacy and can serve as the preferred biomarker for PJI patients with comorbid diabetes.