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Background <p>Periprosthetic 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</p> Methods <p>A 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.</p> Results <p>Nine 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%)</p> Conclusion <p>The 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.</p>

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Diagnostic accuracy of the monocyte-to-lymphocyte ratio in periprosthetic joint infection: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年12月19日

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  • Félix Vílchez-Cavazos,
  • Luis Alejandro Rodríguez-Corpus,
  • Francisco Javier Arrambide-Garza,
  • Carlos Alberto Acosta-Olivo,
  • Mario Simental-Mendía

摘要

Background

Periprosthetic 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

Methods

A 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.

Results

Nine 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%)

Conclusion

The 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.