ArticleJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology2025
Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool?
Article in Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Albumin as a predictor of periprosthetic joint infection in patients undergoing total hip arthroplasty and total knee arthroplasty: a retrospective study.Journal of orthopaedic surgery and research · 2026Article
- Clinical application of synovial fluid albumin-to-globulin ratio as a novel biomarker in diagnosing chronic periprosthetic joint infection.Frontiers in cellular and infection microbiology · 2026Article
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9 authors.
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Abstract
backgroundThis study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. MATERIALS AND
methodsBetween January 2020 and April 2022, patients with failed or painful knee arthroplasty who were admitted to a tertiary referral institution undergoing the standardized diagnostic protocol to identify those with a periprosthetic joint infection (PJI) were analyzed. The 2018 International Consensus Meeting (ICM) criteria were used to classify patients with PJIs and aseptic joints. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve (AUC) of AGR were calculated to define the test's diagnostic accuracy.
resultsThe ROC curve showed that the optimal cutoff value of AGR was 1.43. AGR registered a sensitivity of 95% (95% CI 91-197%), a specificity of 63% (95% CI 56-69%), a positive predictive value of 75% (95% CI 69-81%), and a negative predictive value of 91% (95% CI 86-94%). Receiver operator curve analysis demonstrated an AUC of 0.85 (95% CI 0.77-0.88). Although body mass index (BMI), uremia, glutamic-oxaloacetic transaminase (GOT), international normalized ratio (INR), and alkaline phosphatase showed significant differences between the false positive cases and those cases affected by aseptic failure with AGR higher than 1.43, indicating potential confounding effects (p < 0.05), no parameter was found to be a significant predictor of false positives cases (p > 0.05).
conclusionsFor its high sensitivity, AGR showed potential as a screening tool for detecting infections in PJI diagnostics. LEVEL OF EVIDENCE: III.
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