External Validation of a Septic Arthritis Prognosis Score

N/ACompletedNCT03819855

Rennes University Hospital244 enrolled

Overview

Observational study

Septic arthritis is a diagnostic emergency for acute arthritis because it is accompanied by an excess of mortality of 11% and frequent functional sequelae in about 50% of cases in the year. However, it remains rare with an estimated annual incidence of 1 to 5/100000, and a prevalence of about 10% in front of an acute arthritis table sent to an emergency department. The diagnosis is based on the bacteriological culture which finds the presence of a microorganism within the joint. However, only 80% of septic arthritis is bacteriologically documented due to low inoculum, the presence of fragile bacteria (Neisseria sp) or especially untimely antibiotherapy prior to joint puncture. In addition, the bacteriological culture takes an average of 3 days to become positive, which may delay the implementation of appropriate antibiotic therapy. It is therefore essential that the clinician can rely on other clinical or biological parameters, reliable and fast for better diagnostic orientation. A first study: SYNOLACTATES showed the interest of the measurement of glucose and synovial lactate for the diagnosis of septic arthritis with very good performances. A RESAS score (REnnes Septic Arthritis Score) was constructed from these results to assess the likelihood of septic arthritis.

Study Type

OBSERVATIONAL

Enrollment

244

Conditions

Arthritis

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Any acute arthritis less than or equal to 30 days; * Achievement of a joint puncture in routine care as part of the diagnostic assessment of this acute arthritis; * Affiliation to a social security scheme; * No one opposes his participation in the research. Exclusion Criteria: * Age below 18 years; * Major persons subject to legal protection (safeguard of justice, guardianship, guardianship), persons deprived of their liberty.

Locations (1)

Rennes University Hospital

Rennes, France

Outcomes

Primary Outcomes

RESAS (Rennes Septic Arthritis Score)

Composite score of 4 biological variables of the synovial liquid (macroscopically purulent liquid and/or Synovial White Cells Counts (SWCC) ≥ 75000/mm3, synovial crystal vizualization, synovial lactate dosage, synovial glucose dosage). Each variable is weighted as follows: macroscopically purulent liquid or SWCC ≥ 75000/mm3 (+3 points), UMS (-4 points) or CPP (-2 points) crystal Vizualization, lactate ≥ 11.5 mmol/L (+6 points) or 10-11.4 mmol/L (+4 points) or 8.5-9.9 mmol/L (+2 points), glucose ≤ 1.0 mmol/L (+4 points), 1.1-1.8 mmol/L (+2 points), yielding a total between -4 and 13.

Time frame: Up to 3 days (time to collect laboratory results)

Secondary Outcomes

Macroscopic synovial fluid appearance

Expressed in multiple qualitative variable: purulent, trouble, clear citrine appearance, hemarthrosis or clear with blood threads

Time frame: Up to 1 day (time to collect clinical parameters)

Microscopic synovial analysis

Presence of crystals in synovial fluid: urate monosodic (UMS) crystal (Yes or No), and calcium pyrophosphate crystal (CPP) (Yes or No)

Time frame: Up to 3 days (time to collect laboratory results)

Synovial White Cells Count (SWCC)

Number (n) of White cells in synovial fluid. (quantitative variable expressed in n/mm3)

Time frame: Up to 3 days (time to collect laboratory results)

Total lactates, D-lactate, glucose

Measures of total lactate, D-lactate et glucose in synovial fluid (quantitative variable expressed in mmol/L)

Time frame: Up to 3 days (time to collect laboratory results)

Others synovial proteic markers

Data from ClinicalTrials.gov

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