Plasma Fibrinogen Performs Better Than Plasma d-Dimer and Fibrin Degradation Product in the Diagnosis of Periprosthetic Joint Infection and Determination of Reimplantation Timing

Abstract Background The preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis. Methods We retrospectively analyzed data on patients who underwent re-revision hip or knee arthroplasty at our institute during 2008–2020. Patients were stratified into those who experienced PJI or not, based on 2013 International Consensus Meeting Criteria. Plasma levels of D-dimer and FDP as well as levels of the traditional inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and interleukin-6 were compared between the groups. The ability of these biomarkers to diagnose PJI was assessed based on the area under the receiver operating characteristic (AUC) curve, for which predictive cut-offs were optimized based on the Youden index. Results Based on a cut-off of 0.80 mg/L, D-dimer gave an AUC of 0.595, high sensitivity of 85.7% but poor specificity of 47.8%. Based on a cut-off of 2.80 mg/L, FDP gave an AUC of 0.550, poor sensitivity of 56.5% and poor specificity of 52.9%. CRP, ESR and interleukin-6 showed much better diagnostic ability, with AUCs > 0.82. The combination of CRP and interleukin-6 gave an AUC of 0.877, high sensitivity of 91.7% and acceptable specificity of 78.3%. Conclusions Plasma levels of D-dimer and FDP may be inappropriate for diagnosing PJI in patients undergoing re-revision arthroplasty, whereas the combination of serum CRP and interleukin-6 may be effective.

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Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.18.00624 ◽

2019 ◽

Vol 101 (7) ◽

pp. 613-619 ◽

Cited By ~ 35

Author(s):

Rui Li ◽

Hong-Yi Shao ◽

Li-Bo Hao ◽

Bao-Zhan Yu ◽

Peng-Fei Qu ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Plasma Fibrinogen ◽

D Dimer

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Plasma Fibrinogen, D-dimer, and Fibrin Degradation Product as Biomarkers of Rheumatoid Arthritis

10.21203/rs.3.rs-49004/v1 ◽

2020 ◽

Author(s):

Li Xue ◽

Ming Li ◽

Li Tao ◽

Xueyi Li ◽

Wei Wang ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Roc Curve ◽

Degradation Product ◽

Plasma Fibrinogen ◽

Active Group ◽

Fibrin Degradation Product ◽

Logistical Regression ◽

Inactive Group ◽

D Dimer

Abstract Objective: This study aimed to assess the role of coagulation-related indicators such as plasma ﬁbrinogen (FIB), D-dimer, and fibrin degradation product (FDP) in rheumatoid arthritis (RA) and their association with disease activity.Methods: Data from 105 RA patients and 102 age- and gender- matched healthy controls were collected in the retrospective study. Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) was used to divide the RA patients into inactive group (DAS28-CRP ≤ 2.7) and active group (DAS28-CRP > 2.7). The association between plasma FIB, D-dimer, and FDP and DAS28-CRP was evaluated by spearman correlation. Receiver operating characteristic (ROC) curve was applied to determine the area under curve (AUC) value. The prognostic value of plasma FIB, D-dimer, and FDP in the RA disease activity was tested by logistical regression analysis.Results: RA patients showed higher FAR levels of plasma FIB, D-dimer, and FDP than the controls (P < 0.01). Plasma FIB, D-dimer, and FDP were also increased in active group of RA patients than those in inactive group (P < 0.001). Spearman analysis showed that plasma FIB, D-dimer, and FDP were positively related with DAS28-CRP (P < 0.001) in RA patients. ROC curve analyses revealed that the AUC of D-dimer was higher than ESR and RF, and that of FDP was higher than RF in RA patients. In addition, the optimal cut-oﬀ value of plasma FIB, D-dimer, and FDP for RA diagnosis was 286 mg/dL, 470 μg/L, and 1.45 mg/L, respectively. Logistical regression analyses showed that D-dimer (odds ratio = 2.862, 95% conﬁdence interval: 1.851-4.426, P < 0.001) was a predictor for RA disease activity.Conclusions: FIB, D-dimer, and FDP were increased in RA patients and positively correlated with the disease activity of RA. D-dimer may act as a novel inﬂammatory parameter for predicting disease activity in RA patients.

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Subclinical Abnormal Coagulation in Periprosthetic Joint Infection: A Retrospective Cohort Study

10.21203/rs.3.rs-847259/v1 ◽

2021 ◽

Author(s):

Hao Li ◽

Jun Fu ◽

Wei Chai ◽

Chi Xu ◽

Libo Hao ◽

...

Keyword(s):

Cohort Study ◽

Platelet Count ◽

Periprosthetic Joint Infection ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Joint Infection ◽

Plasma Fibrinogen ◽

Diagnostic Efficacy ◽

Coagulation Profile ◽

D Dimer

Abstract Background：Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty and often indicate disastrous outcomes. However, the change of coagulation profile in PJI patients has not been explored up to now. Therefore, we performed a single-center retrospective cohort study to determine: 1) the coagulation profile in PJI patients 2) the diagnostic efficacy of coagulation profile for PJI diagnosis based on the MSIS criteria.Methods: Between 2016 January and 2018 December, a total of 371 patients receiving joint revisions were included in this cohort study. The corresponding medical records were scrutinized to establish the final diagnosis of PJI according to the 2014 MSIS criteria. The difference of coagulation profile between PJI and aseptic loosening patients was analyzed. Moreover, receiver operating characteristic curves were used to determine the proper sensitivity and specificity of coagulation makers.Results: The levels of APTT, D-dimer, plasma fibrinogen, INR and Platelet Count in PJI group were significantly higher than that in non-PJI group(P<0.05). The AUCs of plasma APTT, plasma D-dimer, plasma fibrinogen and platelet count for PJI diagnosis were0.625(95%CI:(0.543,0.706)),0.731(95%CI:(0.656,0.806)),0.831(95%CI:(0.771,0.890)) and 0.733(95%CI:(0.660,0.805)), respectively. Moreover, the coagulation profile was combined by logistic model and the corresponding AUC was0.865(95%CI:(0.812,0.918)).Conclusions: Despite relatively normal coagulation profile, PJI patients suffer from subclinical abnormal coagulation compared to non-PJI patients. The coagulation profile (APTT, INR, plasma fibrinogen, platelet count, D-dimer) in PJI patients is different from that in non-PJI patients significantly. And the coagulation profile can play a role in PJI diagnosis.

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Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02109-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Liping Pan ◽

Hao Wu ◽

Heng Liu ◽

Xin Yang ◽

Zhichao Meng ◽

...

Keyword(s):

Likelihood Ratio ◽

Periprosthetic Joint Infection ◽

Diagnostic Performance ◽

Meta Analysis ◽

Joint Infection ◽

Negative Likelihood Ratio ◽

Cochrane Library ◽

Sensitivity Specificity ◽

D Dimer ◽

Better Than

Abstract Purpose D-dimer and fibrinogen, both belonging to coagulation parameters, are controversial for the diagnosis of periprosthetic joint infection (PJI). This meta-analysis was conducted to compare their diagnostic accuracies for PJI by synthesizing currently available evidence. Methods Cochrane Library, MEDLINE, Web of Science, and Embase up to March 1, 2020, and other relevant articles were searched. Five hundred and eighty-one articles were identified after initial research, and 11 studies were included finally. No threshold effects were found between studies. The pooled sensitivity, specificity, and positive and negative likelihood ratio were reported to evaluate the diagnostic performance with heterogeneity analysis. Z test statistics was used to analyze the difference of diagnostic performance between D-dimer and fibrinogen. Results The pooled sensitivity, specificity, and positive and negative likelihood ratio of D-dimer for PJI were 0.79 (95% [CI], 0.72–0.85), 0.77 (0.67–0.84), 3.38 (2.21–5.18), and 0.27 (0.18–0.41), respectively. As for fibrinogen, the pooled sensitivity, specificity, and positive and negative likelihood ratio for PJI were 0.75 (0.68–0.80), 0.85 (0.82–0.88), 5.12 (4.22–6.22), and 0.30 (0.23–0.37), respectively. Great heterogeneity was found in studies for D-dimer, and univariate meta-regression analysis revealed that number of involved joints, disease spectrum, comorbidities influencing D-dimer, and sample sources were the source of heterogeneity. Z test found that the pooled specificity of fibrinogen was significantly higher than D-dimer (0.85 ± 0.01 versus 0.77 ± 0.04, p = 0.03). The pooled positive likelihood ratio of fibrinogen was significantly higher than D-dimer (5.12 ± 0.51 versus 3.38 ± 0.74, p = 0.03). Conclusion Based on currently available evidence, the meta-analysis suggests that fibrinogen performs better than D-dimer as a rule-in diagnostic tool for its higher specificity. However, more prospective trials with larger size are still needed to provide further confirmation. Trial registration This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews), and the registering number was CRD42020177176.

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The diagnostic effect of α-defensin, D-dimer, and IL-6 in periprosthetic joint infection: A systematic review and diagnostic meta-analysis

Journal of Orthopaedic Surgery ◽

10.1177/2309499020971861 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902097186

Author(s):

Baozhong Tian ◽

Liwen Cui ◽

Weihai Jiang

Keyword(s):

Systematic Review ◽

Sensitivity And Specificity ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

Common Complication ◽

Online Databases ◽

Artificial Joint Replacement ◽

Sensitivity Specificity ◽

D Dimer

Background: Periprosthetic joint infection (PJI) is the most common complication after artificial joint replacement as previously reported. However, the main problem at present is its difficulty in diagnosis. This systematic review and meta-analysis aimed to compare the diagnostic accuracy of α-defensin, D-dimer, and interleukin-6 (IL-6) in clinical practice. Method: Online databases were systematically searched until June 18th, 2020 with keywords and medical sub-headings terms. Studies mentioned the sensitivity and specificity of biological markers in detecting PJI were included in our study. The sensitivity, specificity, and diagnostic odds ratios (DORs) were obtained after integration. Results: A total of 34 studies with 1036 patients diagnosing as PJI were included for comparing α-defensin, D-dimer, and IL-6. The sensitivity and specificity of α-defensin for PJI were 0.88 and 0.96, and the DOR was 189 (95% CI 72–496), respectively. The sensitivity and specificity of D-dimer (0.82 and 0.72) and IL-6 (0.80 and 0.89) were lower than α-defensin. Conclusion: The detection of α-defensin is a promising biomarker for diagnosing PJI. The optional cut-off needs to be curtained when using other biomarkers.

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Fibrin fragment D-dimer and fibrinogen B beta peptides in plasma as markers of clot lysis during thrombolytic therapy in acute myocardial infarction

Blood ◽

10.1182/blood.v76.7.1341.1341 ◽

1990 ◽

Vol 76 (7) ◽

pp. 1341-1348 ◽

Cited By ~ 29

Author(s):

CM Lawler ◽

EG Bovill ◽

DC Stump ◽

DJ Collen ◽

KG Mann ◽

...

Keyword(s):

Myocardial Infarction ◽

Degradation Product ◽

Degradation Products ◽

Tissue Type ◽

Clot Lysis ◽

Fibrin Degradation Product ◽

Fibrin Degradation Products ◽

Group 2 ◽

D Dimer ◽

Group 1

Abstract The validity of markers in plasma of in vitro thrombolysis was investigated in 12 patients with extensive fibrinogen breakdown (greater than 80%, group 1) and in 12 patients with minimal breakdown (less than 20%, group 2). The patients were treated with 100 mg of recombinant tissue-type plasminogen activator (rt-PA) in the “Thrombolysis in Myocardial Infarction II” (TIMI II) trial. Cross- linked fibrin degradation product levels were measured with two variant enzyme-linked immunosorbent assays (ELISAs), both using a fibrin fragment D-dimer specific capture antibody. In one instance, a tag antibody was used that cross-reacts with fibrinogen (pan-specific tag ELISA); in the other, the tag antibody was specific for fibrin fragment D (fibrin-specific tag ELISA). Apparent concentrations of cross-linked fibrin degradation products at baseline were within normal limits with both assays in most patients. At 8 hours after rt-PA infusion, the measured cross-linked fibrin degradation products were increased about twofold to fourfold in group 2 with both assays. However, in group 1, levels were significantly higher with the pan-specific tag ELISA (5.8 +/- 4.2 micrograms/mL) compared with the fibrin-specific tag ELISA (1.5 +/- 1.3 micrograms/mL). This observation was most likely a result of detection of fibrinogen degradation products in the pan-specific ELISA. Apparent levels of fibrinopeptide B beta 1–42, a marker of fragment X formation, increased during thrombolysis from 4.2 +/- 2.8 pmol/mL to 2,000 +/- 230 pmol/mL in group 1 and from 4.1 +/- 2.1 pmol/mL to 300 +/- 43 pmol/mL in group 2, and were correlated significantly with the extent of fibrinogen breakdown (r = -0.8). Fibrinopeptide beta 15–42 levels increased from 4.3 +/- 3 pmol/mL to 70 +/- 19 pmol/mL in group 1, but did not increase in group 2. The apparent increase in group 1 could be explained by cross-reactivity of fibrinopeptide B beta 1–42 in the fibrinopeptide beta 15–42 assay. We conclude that cross-linked fibrin degradation product levels as measured with a pan-specific tag ELISA and fibrinopeptide beta 15–42 levels as measured with certain monoclonal antibody-based ELISA are influenced by the extent of fibrinogen degradation. Fibrinopeptide B beta 1–42 is a marker specific for fibrinogen breakdown. Cross-linked fibrin degradation product levels, measured with a fibrin-specific tag ELISA, appear to be markers specific for thrombolysis. Consequently, assays similar to the fibrin- specific tag ELISA may provide more accurate information when correlated with clinical endpoints.

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Dithiothreitol is useful for inversion of D-dimer and fibrin degradation product: A case report

Japanese Journal of Medical Technology ◽

10.5833/jamt.13-40 ◽

2014 ◽

Vol 63 (1) ◽

pp. 86-89

Author(s):

Masashi MIYOSHI ◽

Sadanobu MATSUDA ◽

Chihiro INOUE ◽

Norimichi TAKAMATSU ◽

Toshio DOI

Keyword(s):

Case Report ◽

Degradation Product ◽

Fibrin Degradation Product ◽

D Dimer

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Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

10.21203/rs.2.21286/v1 ◽

2020 ◽

Author(s):

Cheng Li ◽

Donara Margaryan ◽

Cristina Ojeda-Thies ◽

Carsten Perka ◽

Andrej Trampuz

Keyword(s):

Likelihood Ratio ◽

Periprosthetic Joint Infection ◽

Degradation Products ◽

Meta Analysis ◽

Joint Infection ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Value ◽

Medical Subject Headings ◽

D Dimer

Abstract Background The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods A systematic search and screen of relevant studies was performed in the PubMed, Web of Science and Embase databases using the following medical subject headings (MeSH) or keywords: “arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint”, “infection or infectious or infected”, and “D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products”. Then, the data were analysed and processed by Meta-Disc software. Results A total of 7 studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 0.75 (95% confidence interval [CI]: 0.70 to 0.79), 0.69 (95% CI: 0.66 to 0.72), 3.01 (95% CI: 1.84 to 4.93), 0.32 (95% CI: 0.19 to 0.53) and 10.20 (95% CI: 3.63 to 28.64), respectively. Subgroup analyses showed that use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI (0.86, 0.84 vs. 0.67, 0.60, respectively). Conclusion Serum D-dimer had a better diagnostic value than plasma D-dimer for the diagnosis of PJI.

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