SynthesisArchives of orthopaedic and trauma surgery2025
Diagnostic accuracy of the monocyte-to-lymphocyte ratio in periprosthetic joint infection: a systematic review and meta-analysis.
Synthesis in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundPeriprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty (TJA). Early diagnosis is challenging, but blood cell ratios offer a cost-effective and accessible tool. This study aimed to evaluate the diagnostic accuracy of the monocyte-to-lymphocyte ratio (MLR) for PJI diagnosis
methodsA systematic review and meta-analysis were conducted using MEDLINE, Scopus, Embase, Web of Science, and Cochrane Central up to September 2024. Cross-sectional studies comparing the diagnostic accuracy of MLR to a standard reference for PJI diagnosis were included. Pooled sensitivity, specificity, likelihood ratios (LR), DOR, and summary receiver operating characteristic (SROC) curve were calculated. Quality was assessed using QUADAS-2 tool.
resultsNine studies with 3,026 participants met the inclusion criteria. The pooled sensitivity and specificity of MLR were 73% (95% CI, 66%−79%; I² = 86.2%) and 70% (95% CI, 61%−78%; I² = 89.9%), respectively. The pooled DOR was 6.51 (95% CI, 4.29−9.88; I² = 80.6%), and the AUC was 0.794. For an MLR cut-off of 0.4, sensitivity was 73% (95% CI, 66%−79%; I² = 80.1%), specificity was 78% (95% CI, 72%−82%; I² = 80.4%), LR+ was 3.21 (95% CI, 2.3−4.4; I² = 50.9%), LR− was 0.34 (95% CI, 0.24−0.49; I² = 56.7%), and DOR was 9.59 (95% CI, 5.3−17.2; I² = 87.4%)
conclusionThe MLR demonstrates moderate diagnostic accuracy for PJI, highlighting its potential as a cost-effective and accessible biomarker. Given the substantial heterogeneity, the current evidence suggests that MLR could serve as a supplementary tool within a broader diagnostic panel, rather than a standalone test. Future research should focus on standardizing cut-off values and validating its clinical application in diverse patient populations.
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