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

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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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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Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.05.009 ◽

2019 ◽

Vol 34 (10) ◽

pp. 2454-2460 ◽

Cited By ~ 26

Author(s):

Hong Xu ◽

Jinwei Xie ◽

Qiang Huang ◽

Yiting Lei ◽

Shaoyun Zhang ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Degradation Product ◽

Joint Infection ◽

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

10.21203/rs.2.21286/v2 ◽

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 screening of relevant studies was performed in the databases PubMed, Web of Science, and Embase 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”. Data were subsequently analysed and processed using Meta-Disc. Results Seven studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.75 (95% confidence interval [CI]: 0.70–0.79), 0.69 (95% CI: 0.66–0.72), 3.01 (95% CI: 1.84–4.93), 0.32 (95% CI: 0.19–0.53), and 10.20 (95% CI: 3.63–28.64), respectively. Subgroup analyses showed that the use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI . Conclusion Serum D-dimer was shown to have a better diagnostic value than plasma D-dimer for the diagnosis of PJI. Further research is required for clarification.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01808-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Cheng Li ◽

Donara Margaryan ◽

Cristina Ojeda-Thies ◽

Carsten Perka ◽

Andrej Trampuz

Keyword(s):

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

D Dimer

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Researchers Assess Serum D-Dimer in Diagnosing Periprosthetic Joint Infection

Lippincott s Bone and Joint Newsletter ◽

10.1097/01.bonej.0000615432.90060.00 ◽

2019 ◽

Vol 25 (11) ◽

pp. 126-127

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

D Dimer

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The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis

Diagnosis ◽

10.1515/dx-2021-0032 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Giovanni Balato ◽

Cristiano De Franco ◽

Fiamma Balboni ◽

Vincenzo De Matteo ◽

Tiziana Ascione ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Blood Sample ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Receiver Operating Curve ◽

Sensitivity Specificity ◽

D Dimer

Abstract Objectives The current literature on diagnosis of periprosthetic joint infection (PJI) provides controversial evidence on the diagnostic accuracy of D-dimer. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of D-dimer for diagnosing PJI. Content We searched MEDLINE, Scopus, and Web of Science, for studies on D-dimer for diagnosing PJI, according to the PRISMA flowchart. QUADAS was used for assessing study quality. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed using bivariate diagnostic random-effects model. The area under the receiver-operating curve (AUC-ROC) was calculated. Subgroup analysis and univariate meta-regression were carried out for detecting potential sources of heterogeneity. Summary We included 12 articles, totaling 1,818 patients (539 with PJI). The pooled sensitivity and specificity of D-dimer for diagnosing PJI were 0.739 (95% CI: 0.616–0.833) and 0.785 (95% CI: 0.679–0.863). The pooled PLR, NLR, DOR were 3.359 (95% CI, 2.340–4.821), 0.295 (95% CI, 0.180–0.484), and 11.787 (95% CI, 5.785–24.018). The cumulative ROC plot displayed an AUC of 0.688 (95% CI, 0.663–0.713; p<0.001). No threshold effects could be observed. The type of blood sample was identified as possible source of heterogeneity for DOR (p=0.01). Outlook Evidence emerged from this meta-analysis suggests that D-dimer displays sufficient diagnostic accuracy to rule out PJI. The type of blood sample (plasma vs. serum) and the study design could influence the results in terms of DOR and sensitivity. However, further perspective studies would be needed to validate its potential diagnostic usefulness.

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