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Background <p>This study aimed to analyze both hematological and synovial biomarkers in patients with septic arthritis (SA) and patients with non-septic arthritis (non-SA) of the knee and identify useful biomarkers for the early diagnosis of SA in emergency medical practice.</p> Methods <p>We examined 397 knee joints of 367 patients with painful/swollen knee joints and potential infection at our department between May 2018 and May 2023. After excluding cases involving joints with prosthetic replacements, symptom duration more than 3 weeks, prior antibiotic use, and absence of arthrocentesis, 179 knee joints (166 patients) were assessed. To identify useful diagnostic parameters of the SA and non-SA groups, we compared their hematological and synovial fluid biomarkers and assessed the diagnostic performance of those biomarkers by conducting receiver-operating characteristic (ROC) analyses.</p> Results <p>Hematological parameters, including the white blood cell (WBC) count, neutrophil sequestration, C-reactive protein level, and procalcitonin level, in the SA group were higher than those in the non-SA group. A synovial fluid examination revealed that the WBC count and neutrophil sequestration exhibited the same pattern. Synovial glucose levels and synovial-to-blood glucose ratios in the SA group were lower than those in the non-SA group. The ROC analysis revealed that the synovial-to-blood glucose ratio had the highest diagnostic utility for predicting SA.</p> Conclusions <p>The synovial-to-blood glucose ratio appears to be a promising biomarker; however, its ability to differentiate SA from non-SA warrants further validation. The synovial-to-blood glucose ratio may complement existing diagnostic tools and improve early diagnostic precision in emergency medical settings.</p>

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Synovial-to-blood glucose ratio as a biomarker for the early diagnosis of septic arthritis of the knee in emergency medical practice: a retrospective clinical cohort study

  • 期刊论文

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  • 发表日期：

    2026年1月12日

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  • Hiroshi Okuno,
  • Shinjiro Miura,
  • Kiyotsugu Shinagawa,
  • Tomonori Kunii,
  • Daisuke Chiba,
  • Hiroaki Ogawa,
  • Shingo Nobuta,
  • Toshimi Aizawa,
  • Eiji Itoi

摘要

Background

This study aimed to analyze both hematological and synovial biomarkers in patients with septic arthritis (SA) and patients with non-septic arthritis (non-SA) of the knee and identify useful biomarkers for the early diagnosis of SA in emergency medical practice.

Methods

We examined 397 knee joints of 367 patients with painful/swollen knee joints and potential infection at our department between May 2018 and May 2023. After excluding cases involving joints with prosthetic replacements, symptom duration more than 3 weeks, prior antibiotic use, and absence of arthrocentesis, 179 knee joints (166 patients) were assessed. To identify useful diagnostic parameters of the SA and non-SA groups, we compared their hematological and synovial fluid biomarkers and assessed the diagnostic performance of those biomarkers by conducting receiver-operating characteristic (ROC) analyses.

Results

Hematological parameters, including the white blood cell (WBC) count, neutrophil sequestration, C-reactive protein level, and procalcitonin level, in the SA group were higher than those in the non-SA group. A synovial fluid examination revealed that the WBC count and neutrophil sequestration exhibited the same pattern. Synovial glucose levels and synovial-to-blood glucose ratios in the SA group were lower than those in the non-SA group. The ROC analysis revealed that the synovial-to-blood glucose ratio had the highest diagnostic utility for predicting SA.

Conclusions

The synovial-to-blood glucose ratio appears to be a promising biomarker; however, its ability to differentiate SA from non-SA warrants further validation. The synovial-to-blood glucose ratio may complement existing diagnostic tools and improve early diagnostic precision in emergency medical settings.