The role of Presepsin and Maresin 1 levels in blood and synovial fluid in early diagnosis of Septic arthritis

Septic arthritis is an inflammation of the synovial membrane and fluid in the joints caused by bacterial, viral or fungal agents. Ideally, bacteria should be demonstrated in the synovial fluid. However, since bacterial growth in synovial fluid is low, the diagnosis is mostly based on the results of clinical, physical examination and laboratory findings and the ability to diagnose accurately is limited. The clinical importance of septic arthritis stems from the fact that it may leave sequelae as a result of delay in diagnosis or inadequate treatment. For this reason, many studies are currently being conducted to find biomarkers with high sensitivity and specificity that allow rapid diagnosis before cartilage damage occurs. One of the markers emphasized as an indicator of infection in recent years is serum presepsin level. Increased blood presepsin levels in sepsis, pneumonia and other bacterial infections are remarkable. Maresin-1 is one of the prominent metabolites of eicosapentaenoic acid (EPA) which shows strong anti-inflammatory effects in inflammatory diseases. In this study, we aimed to compare presepsin and maresin-1 levels in serum and synovial fluid in the early diagnosis of septic arthritis. Our study is a single-center, prospective case-control study. Our study included 70 patients admitted to Firat University Faculty of Medicine Hospital between July 2022 and October 2023. Patients included in the study were evaluated as septic arthritis according to Newman criteria and retrospective follow-up. Presepsin and maresin-1 levels, which we recommend as a new diagnostic test, were analyzed in serum and synovial fluid. Presepsin level was found to be more significant in synovial yeast than in serum, with a cut-off value of 1407.3 ng/L in serum and 3445.5 ng/L in synovial yeast. Maresin-1 levels were found to be insignificant for the diagnosis of septic arthritis in both serum and synovial yeast. The fact that the control group did not consist of completely healthy individuals was considered as an important reason for the insignificant level of Maresin-1. It was observed that presepsin level could be used as a predictive value in doubtful cases. Especially the diagnostic performance for synovial fluid presepsin levels was higher than serum presepsin levels. We are of the opinion that a more comprehensive study will provide more meaningful results by following up the patients' advanced findings and revealing whether the patients have septic arthritis or not and the clinical and laboratory differences between these two groups. Key words: Septic arthritis, presepsin, maresin-1