{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:18:06Z","timestamp":1789651086658,"version":"4.0.0"},"reference-count":41,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002642","name":"Korea University","doi-asserted-by":"publisher","award":["K1613721"],"award-info":[{"award-number":["K1613721"]}],"id":[{"id":"10.13039\/501100002642","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Septic arthritis is an orthopedic emergency. However, optimal biomarkers and diagnostic criteria remain unclear. The study aimed to evaluate the diagnostic performance of routinely used and novel biomarkers, including serum C-reactive protein (CRP), synovial white blood cells (WBC), pentraxin-3 (PTX3), interleukin-6 (IL-6), and presepsin, in distinguishing septic from non-septic arthritis. Methods: Thirty-one patients undergoing arthrocentesis were included. Patients were categorized into septic and non-septic arthritis groups. Synovial fluid and serum samples were analyzed for five biomarkers. Diagnostic performance was assessed by calculating the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Synovial WBC demonstrated the highest diagnostic performance among single biomarkers (AUC = 0.837, p = 0.012). Among novel biomarkers, PTX3 showed the highest accuracy and sensitivity. The serum CRP and synovial WBC combination yielded an AUC of 0.853, with 100% sensitivity, 68.0% specificity, 42.9% PPV, and 100% NPV. Adding all three novel biomarkers to this combination increased the AUC to 0.887 (p = 0.004), maintaining 100% sensitivity and NPV. When individually added, PTX3 achieved 100% sensitivity and NPV, while presepsin showed the highest specificity (96.0%), PPV (75.0%), and accuracy (87.1%). Conclusions: Serum CRP and synovial WBC remain essential biomarkers for diagnosing septic arthritis; however, combining them with PTX3, IL-6, and presepsin improved diagnostic accuracy. PTX3 is best suited for ruling out septic arthritis due to its high sensitivity and NPV, whereas presepsin is more useful for confirmation, given its specificity and PPV. These results support a tailored biomarker approach aligned with diagnostic intent.<\/jats:p>","DOI":"10.3390\/jcm14155415","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T07:49:58Z","timestamp":1754380198000},"page":"5415","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Enhanced Diagnostic Accuracy for Septic Arthritis Through Multivariate Analysis of Serum and Synovial Biomarkers"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0064-9937","authenticated-orcid":false,"given":"Hyung Jun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hoon","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6217-7360","authenticated-orcid":false,"given":"Juhyun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2032-9538","authenticated-orcid":false,"given":"Hyeri","family":"Seok","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Kyoung","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won Suk","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungjae","family":"Choi","sequence":"additional","affiliation":[{"name":"Family Medicine, Providence St. Joseph Hospital, Eureka, CA 95501, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung-Hyun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hun","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Gyoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Won","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/jama.297.13.1478","article-title":"Does this adult patient have septic arthritis?","volume":"297","author":"Margaretten","year":"2007","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/S0140-6736(09)61595-6","article-title":"Bacterial septic arthritis in adults","volume":"375","author":"Mathews","year":"2010","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e0059","DOI":"10.2106\/JBJS.RVW.19.00059","article-title":"Bacterial Septic Arthritis of the Adult Native Knee Joint: A Review","volume":"8","author":"Elsissy","year":"2020","journal-title":"JBJS Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s43019-024-00248-z","article-title":"Does septic arthritis after anterior cruciate ligament reconstruction lead to poor outcomes? 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