Common Serum Biomarkers and Combination Ratios in the Diagnosis of Periprosthetic Joint Infection Following Total Hip Arthroplasty

Authors

• Jason M Dayan
• Don H Le
• Anzar Sarfraz
• Theodor Di Pauli von Treuheim
• Farouk Khury
• Sallie Yassin
• Vinay K Aggarwal
• Ran Schwarzkopf
• Alan J Dayan

Language

English

Publication Date

2-13-2026

Journal

Microorganisms

DOI

10.3390/microorganisms14020461

PMID

41753746

PMCID

PMC12942761

PubMedCentral® Posted Date

2-13-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Accurate preoperative diagnosis of periprosthetic joint infection (PJI) is difficult, complicating distinction between septic and aseptic failures. This study assessed the value of common serum biomarkers and three calculated ratios-albumin-globulin ratio (AGR), C-reactive protein-albumin ratio (CAR), and C-reactive protein-AGR ratio (CAGR)-in diagnosing PJI after primary total hip arthroplasty (THA). We retrospectively reviewed patients undergoing revision THA for PJI or aseptic failure from 2011 to 2021 at a single institution. Inclusion required reported serum white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin (Alb), and total protein (TP). Diagnostic performance was evaluated using areas under the curve (AUCs), with higher values indicating better accuracy. Ratios were defined as: AGR = Alb/[TP - Alb], CAR = CRP/Alb, and CAGR = CRP/AGR. Among 128 cases, 67 were PJI and 61 aseptic. AUCs were: WBC (0.53), CRP (0.69), ESR (0.75), Alb (0.69), Glb (0.63), TP (0.53), AGR (0.72), CAR (0.70), and CAGR (0.71). Optimal cutoff, sensitivity, and specificity were: CRP (10.5, 0.76, 0.59), ESR (41.0, 0.70, 0.72), AGR (1.10, 0.64, 0.75), CAR (3.37, 0.73, 0.64), and CAGR (10.9, 0.75, 0.66). ESR, AGR, CAR, and CAGR demonstrated acceptable accuracy. These readily available markers and ratios may aid PJI diagnosis, supporting improved clinical decision-making.

Keywords

periprosthetic joint infection (PJI), albumin, globulin, erythrocyte sedimentation rate (ESR), total protein, albumin–globulin ratio (AGR), CRP–albumin ratio (CAR), CRP-AGR ratio (CAGR)

Published Open-Access

yes

Recommended Citation

Dayan, Jason M; Le, Don H; Sarfraz, Anzar; et al., "Common Serum Biomarkers and Combination Ratios in the Diagnosis of Periprosthetic Joint Infection Following Total Hip Arthroplasty" (2026). Faculty, Staff and Student Publications. 191.
https://digitalcommons.library.tmc.edu/uthdb_docs/191