Evaluation of neutrophil gelatinase-associated lipocalin precision in periprosthetic joint infection diagnosis

This study assesses neutrophil gelatinase-associated lipocalin (NGAL) as a diagnostic biomarker for periprosthetic joint infection (PJI). A comprehensive search in multiple databases (Cochrane Library, Scopus, OVID, PubMed, Web of Science, and Embase) identified relevant studies on NGAL for PJI diagnosis until September 2023. Pooled sensitivity and specificity for NGAL, alongside other biomarkers (CRP, ESR, SF-WBC, D-dimer, and PCT), were analysed. Across nine studies, NGAL showed high diagnostic accuracy with pooled sensitivity of 0.93 and specificity of 0.90. Other markers showed lower sensitivity (ESR: 0.81, CRP: 0.75, SF-WBC: 0.91, D-dimer: 0.43, PCT: 0.65) and specificity (ESR: 0.90, CRP: 0.93, SF-WBC: 0.86, D-dimer: 0.93, PCT: 0.93). The diagnostic odds ratio (DOR) for NGAL (132.89) surpassed other markers, supporting NGAL as a superior diagnostic tool for PJI.