Startseite Medizin Synovial fluid D-lactate – a pathogen-specific biomarker for septic arthritis: a prospective multicenter study
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Synovial fluid D-lactate – a pathogen-specific biomarker for septic arthritis: a prospective multicenter study

  • Svetlana Karbysheva ORCID logo EMAIL logo , Paula Morovic , Petri Bellova , Marvin Sven Berger , Maik Stiehler , Sebastian Meller , Stephanie Kirschbaum , Philippe Lindenlaub , Armin Zgraggen , Michael Oberle , Michael Fuchs , Carsten Perka , Andrej Trampuz und Anna Conen
Veröffentlicht/Copyright: 26. September 2024
Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 63 Heft 2

Abstract

Objectives

The performance of synovial fluid biomarker D-lactate to diagnose septic arthritis (SA) and differentiate it from crystal-induced arthritis (CA), other non-infectious rheumatic joint diseases (RD) and osteoarthrosis (OA) was evaluated.

Methods

Consecutive adult patients undergoing synovial fluid aspiration due to joint pain were prospectively included in different German and Swiss centers. Synovial fluid was collected for culture, leukocyte count and differentiation, detection of crystals, and D-lactate concentration. Youden’s J statistic was used to determine optimal D-lactate cut-off value on the receiver operating characteristic (ROC) curve by maximizing sensitivity and specificity.

Results

In total 231 patients were included. Thirty-nine patients had SA and 192 aseptic arthritis (56 patients with OA, 68 with CA, and 68 with RD). The median concentration of synovial fluid D-lactate was significantly higher in patients with SA than in those with OA, CA, and RD (p<0.0001, p<0.0001 and p<0.0001, respectively). The optimal cut-off of synovial fluid D-lactate to diagnose SA was 0.033 mmol/L with a sensitivity of 92.3 % and specificity of 85.4 % independent of previous antimicrobial treatment. Sensitivity and specificity of synovial fluid leukocyte count at a cut-off of 20,000 cells/µL was 81.1 % and 80.8 %, respectively.

Conclusions

Synovial fluid D-lactate showed a high performance for diagnosing SA which was superior to synovial fluid leukocyte count. Given its high sensitivity and specificity, it serves as both an effective screening tool for SA and a differentiator between SA and RD, especially CA.

Keywords: biomarker; diagnosis; D-lactate; septic arthritis; synovial fluid
Corresponding author: Svetlana Karbysheva, Charité – University Medicine Berlin Center for Musculoskeletal Surgery Charitéplatz 1, 10117 Berlin, Germany; Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany, E-mail:

Acknowledgments

We thank the study nurse, Cornelia Krismer, for the support in data acquisition, as well as the laboratory staff handling in the Cantonal Hospital Aarau, and the study nurse, Anne Schützer, for helping with establishing and maintaining the study infrastructure in the Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden.

  1. Research ethics: Approval of the respective Institutional Review Boards (EA1/026/20, EKNZ 2020-00438, BO-EK-431092021, FSta 40/20) was available. The study was done in accordance with the Declaration of Helsinki.

  2. Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-0556).

Received: 2024-05-05
Accepted: 2024-08-15
Published Online: 2024-09-26
Published in Print: 2025-01-29

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2024-0556
Schlagwörter für diesen Artikel
biomarker; diagnosis; D-lactate; septic arthritis; synovial fluid

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. CD34+ progenitor cells meet metrology
  4. Reviews
  5. Venous blood collection systems using evacuated tubes: a systematic review focusing on safety, efficacy and economic implications of integrated vs. combined systems
  6. The correlation between serum angiopoietin-2 levels and acute kidney injury (AKI): a meta-analysis
  7. Opinion Papers
  8. Advancing value-based laboratory medicine
  9. Clostebol and sport: about controversies involving contamination vs. doping offence
  10. Direct-to-consumer testing as consumer initiated testing: compromises to the testing process and opportunities for quality improvement
  11. Perspectives
  12. An improved implementation of metrological traceability concepts is needed to benefit from standardization of laboratory results
  13. Genetics and Molecular Diagnostics
  14. Comparative analysis of BCR::ABL1 p210 mRNA transcript quantification and ratio to ABL1 control gene converted to the International Scale by chip digital PCR and droplet digital PCR for monitoring patients with chronic myeloid leukemia
  15. General Clinical Chemistry and Laboratory Medicine
  16. IVDCheckR – simplifying documentation for laboratory developed tests according to IVDR requirements by introducing a new digital tool
  17. Analytical performance specifications for trace elements in biological fluids derived from six countries federated external quality assessment schemes over 10 years
  18. The effects of drone transportation on routine laboratory, immunohematology, flow cytometry and molecular analyses
  19. Accurate non-ceruloplasmin bound copper: a new biomarker for the assessment and monitoring of Wilson disease patients using HPLC coupled to ICP-MS/MS
  20. Construction of platelet count-optical method reflex test rules using Micro-RBC#, Macro-RBC%, “PLT clumps?” flag, and “PLT abnormal histogram” flag on the Mindray BC-6800plus hematology analyzer in clinical practice
  21. Evaluation of serum NFL, T-tau, p-tau181, p-tau217, Aβ40 and Aβ42 for the diagnosis of neurodegenerative diseases
  22. An immuno-DOT diagnostic assay for autoimmune nodopathy
  23. Evaluation of biochemical algorithms to screen dysbetalipoproteinemia in ε2ε2 and rare APOE variants carriers
  24. Reference Values and Biological Variations
  25. Allowable total error in CD34 cell analysis by flow cytometry based on state of the art using Spanish EQAS data
  26. Clinical utility of personalized reference intervals for CEA in the early detection of oncologic disease
  27. Agreement of lymphocyte subsets detection permits reference intervals transference between flow cytometry systems: direct validation using established reference intervals
  28. Cancer Diagnostics
  29. Atypical cells in urine sediment: a novel biomarker for early detection of bladder cancer
  30. External quality assessment-based tumor marker harmonization simulation; insights in achievable harmonization for CA 15-3 and CEA
  31. Cardiovascular Diseases
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  36. Targeted MRM-analysis of plasma proteins in frozen whole blood samples from patients with COVID-19: a retrospective study
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  39. Urgent need to adopt age-specific TSH upper reference limit for the elderly – a position statement of the Belgian thyroid club
  40. Sigma metric is more correlated with analytical imprecision than bias
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  42. Simple flow cytometry method using a myeloma panel that easily reveals clonal proliferation of mature B-cells
  43. Is sweat conductivity still a relevant screening test for cystic fibrosis? Participation over 10 years
  44. Hb D-Iran interference on HbA1c measurement
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