Performance of a new rapid diagnostic test the lactate/glucose ratio of synovial fluid for the diagnosis of septic arthritis - 13/06/20
, Guillaume Coiffier a, b, Jean-David Albert a, b, Anne Gougeon-Jolivet b, c, Claire Goussault a, Claude Bendavid d, e, Pascal Guggenbuhl bBienvenue sur EM-consulte, la référence des professionnels de santé.
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| Iconographies | 3 |
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| Autres | 0 |
Highlights |
• | Septic arthritis is a diagnostic emergency. However, this diagnosis is not evident among all acute arthritis. |
• | In this cross-sectional study, that included 233 acute arthritis, lactate levels were higher in the septic group. The AUC of lactate was 0.795. |
• | Glucose levels were lower in the septic group and the AUC of glucose was 0.833. Lactate/Glucose ratio AUC was 0.859. |
• | These synovial markers allow septic arthritis to be distinguished more quickly than culture from other acute arthritis. |
Abstract |
Objective |
To evaluate the diagnostic performance of the synovial lactate, glucose and lactate/glucose ratio assay for the diagnosis of septic arthritis.
Methods |
In this monocentric cross-sectional study, synovial fluids were prospectively obtained from patients with acute joint effusion (<30 days) on native joint. Septic arthritis was defined using Newman's criteria. To evaluate diagnostic performance, Receiver Operating Characteristic (ROC) curves with Area under the curve (AUC), Sensitivities (Se), Specificities (Sp), LR+ their 95% confidence intervals were calculated. Synovial fluid cultures with gram staining, crystal analyses, synovial fluid white blood cell counts (WBC), lactate and glucose assays were performed.
Results |
A total of 233 synovial fluids were included. 25 patients had septic arthritis and 208 had non-septic arthritis (104 crystal-induced arthritis, 15 RA, 8 SpA, 6 reactive arthritis, and 75 acute arthritis of undifferentiated origin). Synovial lactate/glucose ratio performed higher than the synovial lactate or glucose assay separately (AUC: 0.859 [0.772–0.945]). Best synovial lactate/glucose ratio threshold to differentiate septic arthritis from non-septic arthritis was 5 Se 52% [0.34–0.7], Sp 98.1% [0.95–0.99], LR+ 27.0[9.50–76.00]).
Conclusion |
The diagnostic performance of synovial lactate/glucose allows septic arthritis to be effectively and very quickly distinguished from other types of arthritis.
Le texte complet de cet article est disponible en PDF.Keywords : Septic arthritis, Synovial fluid, Lactate, Glucose, Ratio lactate/glucose, Acute arthritis
Plan
Vol 87 - N° 4
P. 343-350 - juillet 2020 Retour au numéro
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