Does CRP to Albumin Ratio potentially predict success or failure of DAIR and chronicity of infection?

Introduction: Periprosthetic joint infection (PJI) is a serious complication of joint replacement, with limited consensus on optimal treatment, especially in early infections. Debridement, antibiotics, and implant retention (DAIR) is often used, but determining the true duration of symptoms—and thus infection chronicity—can be challenging. CRP levels rise in both early and chronic infections, while albumin levels decline more gradually due to increased vascular permeability in chronic cases. The CRP-to-albumin ratio may serve as a useful marker of infection chronicity, potentially aiding in treatment decisions between DAIR and more aggressive options used for chronic infections. Methods: A retrospective longitudinal study was conducted on 35 consecutive patients, reviewing hospital admission CRP and albumin levels, along with patient-reported symptom onset. The study assessed the correlation between these variables and 1-year clinical outcomes following the DAIR procedure. In addition, CRP-to-albumin ratios were analyzed in a separate group of patients with chronic infections undergoing resection arthroplasty to identify potential similarities between these treatment groups. Results: Twenty-seven patients were classified as acute infection (0–28 days of symptoms), and 8 patients were classified as having chronic infection (≥29 days). An additional 39 patients with symptoms >3 months who underwent resection arthroplasty were included for comparison. Median CRP/albumin ratios were 5.8 (CRP 20.8 mg/L, albumin 3.4 g/dL) in the acute group, 0.8 (CRP 2.4 mg/L, albumin 3.8 g/dL) in the chronic group, and 5.6 (CRP 23.3 mg/L, albumin 3.8 g/dL) in the resection group. Conclusions: The use of CRP-to-albumin ratio to predict acute versus chronic infection of total joint arthroplasty does not appear to provide any substantial insights for the surgeon providing care. Additional studies are needed to help provide direction in patient management of these difficult complications.