Evidence map›Paper›PMID 29557491›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018

A meta-analysis of synovial biomarkers in periprosthetic joint infection: Synovasure™ is less effective than the ELISA-based alpha-defensin test.

Sufian S Ahmad, Michael T Hirschmann, Roland Becker, Ahmed Shaker, Atesch Ateschrang, Marius J B Keel, Christoph E Albers, Lukas Buetikofer, Sithombo Maqungo, Ulrich Stöckle and 1 more

Open access · bronzeAbstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 4 pooled it
7.3field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 4 syntheses or guidelines pooled it, 58 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Review
  7. Article
  8. Review
  9. Review
  10. Review
  11. Review
  12. Article
  13. Review
  14. Review
  15. Enhancing Diagnostics in Orthopedic Infections.Journal of clinical microbiology · 2022
    Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 3 countries.

Sufian S AhmadDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland. sufian@ahmadortho.com.
Michael T HirschmannDepartment of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland.
Roland BeckerDepartment of Orthopedics and Traumatology, Centre of Joint Replacement, Hospital Brandenburg, Medical School "Theodor Fontane", Hochstrasse 2, 14770, Brandenburg/havel, Germany.
Ahmed ShakerDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland.
Atesch AteschrangDepartment of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Marius J B KeelDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland.
Christoph E AlbersDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland.
Lukas BuetikoferClinical trials unit, University of Bern, Bern, Switzerland.
Sithombo MaqungoDepartment of Orthopaedic Surgery and Traumatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Ulrich StöckleDepartment of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Sandro KohlDepartment of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland.
University Hospital of Bern · CHUniversity of Tübingen · DEKantonsspital Baselland Standort Bruderholz · CHKlinik Hirslanden · CHKlinikum Brandenburg · DEUniversity of Bern · CHUniversity of Cape Town · ZA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purpose(1) To determine the overall accuracy of synovial alpha-defensin, synovial C-reactive protein (sCRP), interleukin-6 (sIL-6), and leukocyte esterase (sLE) as diagnostic markers for periprosthetic joint infection (PJI) and (2) to independantly evaluate the accuracy of both the laboratory-based ELISA alpha-defensin test and the Synovasure™ alpha-defensin test kit.

methodsAn EMBASE and MEDLINE (PubMed) database search was performed using a set of professionally set search terms. Two independent reviewers rated eligible articles. Sensitivity and specificity were meta-analysed using a bivariate random-effects model.

resultsAccuracy values were extracted from 42 articles. Pooled sensitivity and specificity of the represented biomarkers were: alpha-defensin ELISA 0.97 (95% CI 0.91-0.99) and 0.97 (95% CI 0.94-0.98), respectively; Synovasure™ test kit assay 0.80 (95% CI 0.65-0.89) and 0.89 (95% CI 0.76-0.96), respectively; sLE 0.79 (95% CI 0.67-0.87) and 0.92 (95% CI 0.87-0.92), respectively; sIL-6 0.76 (95% CI 0.65-0.84) and 0.91 (95% CI 0.88-0.94), respectively; sCRP 0.86 (95% CI 0.81-0.91) and 0.90 (95% CI 0.86-0.93), respectively.

conclusionThe labararory-based alpha-defensin ELISA test showed the highest ever reported accuracy for PJI diagnosis. However, this did not apply for the Synovasure™ alpha-defensin test, which was comparable in its overall diagnostic accuracy to sCRP, sIL-6 and sLE. The later biomarkers also did not yield an overall diagnostic accuracy higher than that previously reported for synovial white cell count (sWBC) or culture bacteriology. Based on current evidence, no synovial biomarker should be applied as a standalone diagnostic tool. Furthermore, the use of the laboratory-based alpha-defensin ELISA test should be encouraged, still, the Synovasure™ alpha-defensin test kit should be critically appreciated. LEVER OF EVIDENCE: III.

Indexed as

alpha-DefensinsBiomarkersCarboxylic Ester HydrolasesC-Reactive ProteinEnzyme-Linked Immunosorbent AssayHumansInterleukin-6Prosthesis-Related InfectionsSensitivity and SpecificitySynovial Fluidalpha-DefensinsBiomarkersCarboxylic Ester HydrolasesC-Reactive ProteinInterleukin-6leukocyte esteraseAlpha defensinAlpha-defensinBiomarkerInterleukin 6Interleukin-6Leukocyte esterase, CRPSynovasureSynovialSynovial CRPSynovial interleukin-6α Defensinα-Defensin

Identifiers

PMID29557491
OpenAlexW2789690898

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.