Diagnostic Accuracy of D-Dimer in Periprosthetic Joint Infection: a diagnostic meta-analysis

Abstract Background: Periprosthetic joint infection (PJI) is one of the most devastating complications after total joint replacement. Up to now, the diagnosis of PJI is still in a dilemma. As a novel biomarker, whether D-Dimer is valuable in the diagnosis of PJI remains controversial. This meta-analysis attempts to determine the diagnostic accuracy of D-Dimer in PJI.Methods: Relevant literature was retrieved from PubMed, Embase, Web of Science, and Cochrane Library (from database establishment to April 2020). Literature quality was evaluated using Revman (Version 5.3). The random effect model was used in Stata version 14.0 software to combine sensitivity, specificity, likelihood ratio (LR), diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve and area under SROC (AUC) to evaluate the diagnostic value of overall D-Dimer for PJI. Meta regression and subgroup analysis were performed according to the threshold, the study design, the sample size, the diagnostic gold standard, the country of study, and the type of sample.Results:A total of 9 studies were included in this study, including 1592 patients. The pooled sensitivity and specificity of D-Dimer for PJI diagnosis are 0.82(95%CI, 0.72~0.89) and 0.73(95%CI, 0.58~0.83), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 2.99 (95%CI, 1.84~4.88) and 0.25 (95%CI, 0.15~0.41), respectively. The pooled AUC and diagnostic odds ratios were 0.85 (95%CI, 0.82~0.88) and 12.20 (95% CI, 4.98~29.86), respectively.Conclusion: D-Dimer is a promising biomarker for the diagnosis of PJI, which should be used in conjunction with other biomarkers or as an adjunct to other diagnostic methods to enhance diagnostic performance.

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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 sonicate fluid in blood culture bottles for diagnosing periprosthetic joint infection

Journal of Bone and Joint Infection ◽

10.7150/jbji.29731 ◽

2018 ◽

Vol 3 (5) ◽

pp. 273-279 ◽

Cited By ~ 11

Author(s):

Cheng Li ◽

Nora Renz ◽

Cristina Ojeda Thies ◽

Andrej Trampuz

Keyword(s):

Blood Culture ◽

Likelihood Ratio ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Methods ◽

Summary Receiver Operating Characteristic

Abstract. Introduction: Periprosthetic joint infection (PJI) is the most serious complication after arthroplasty, and the diagnosis of PJI is still challenging with modern medical technology. To improve the diagnostic rate, combined diagnostic methods are gradually beginning to be used to diagnose PJI. Sonication is one accurate way to diagnose PJI, but there is minimal research regarding the diagnostic value of sonicate fluid (SF) in blood culture bottles (BCB). Therefore, we evaluated this combined diagnostic method by meta-analysis.Methods: We searched English publications in electronic databases regarding the use of sonicate fluid in blood culture bottles (SF-BCB) for diagnosing PJI, screened the literature according to inclusion criteria, assessed the quality of the selected literature, and collected information regarding SF-BCB.Results: This meta-analysis includes 4 studies that evaluated SF-BCB for the diagnosis of PJI. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) are 0.85 (95% Confidence interval [CI], 0.77 to 0.91), 0.86 (CI, 0.81 to 0.91), 5.34 (CI, 3.13 to 9.11), 0.16 (CI, 0.06 to 0.48) and 39.01 (CI, 9.04 to 168.35), respectively. The area under the curve (AUC) of the summary receiver operating characteristic (SROC) is 0.9186 (standard error, 0.0205).Conclusion: SF-BCB has great value for the microbiological diagnosis of PJ, especially for patients with prior antibiotic treatment.

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Diagnostic accuracy of calprotectin in periprosthetic joint infection: a diagnostic meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02895-4 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Jisi Xing ◽

Jiahao Li ◽

Zijian Yan ◽

Yijin Li ◽

Xiaofang Liu ◽

...

Keyword(s):

Likelihood Ratio ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Characteristic Curve ◽

Joint Infection ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Cochrane Library ◽

Sensitivity Specificity

Abstract Background Periprosthetic joint infection (PJI) is considered to be one of the most challenging complications of joint replacement, which remains unpredictable. As a simple and emerging biomarker, calprotectin (CLP) has been considered to be useful in ruling out PJI in recent years. The purpose of this study was to investigate the accuracy and sensitivity of CLP in the diagnosis of PJI. Methods We searched and screened the publications from PubMed, Web of Science, EMBASE, and Cochrane Library from database establishment to June 2021. Subsequently, Stata version 16.0 software was used to combine the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), operating characteristic curve, and area under the curve (AUC). Heterogeneity across articles was evaluated by the I2 statistics. Finally, sources of heterogeneity were detected by subgroup analysis based on study design, detection method, sample size, and cutoff values. Results A total of 7 studies were included in our study, comprising 525 patients. The pooled sensitivity, specificity, PLR, and NLR of CLP for PJI diagnosis were 0.94(95% CI 0.87–0.98), 0.93(95% CI 0.87–0.96), 13.65(95% CI 6.89–27.08), and 0.06(95% CI 0.02–0.15), respectively, while the DOR and AUC were 222.33(95% CI 52.52–941.11) and 0.98 (95% CI 0.96–0.99), respectively. Conclusion Synovial CLP is a reliable biomarker and can be used as a diagnostic criterion for PJI in the future. However, the uncertainty resulting from the poor study numbers and sample sizes limit our ability to definitely draw conclusions on the basis of our study.

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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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Use of the A2DS2 scale to predict morbidity in stroke-associated pneumonia: a systematic review and meta-analysis

BMC Neurology ◽

10.1186/s12883-021-02060-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jie Huang ◽

Ming Liu ◽

Weiliang He ◽

Feifei Liu ◽

Jinming Cheng ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Meta Analysis ◽

Random Effect Model ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Cochrane Library ◽

Clinical Applicability ◽

Test Probability

Abstract Background This review aims to evaluate the performance and clinical applicability of the A2DS2 scale via systematic review and meta-analysis. Methods The Medline, Embase, Cochrane Library, CBM, CNKI, and Wanfang databases were searched. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Funnel plots and Egger’s test were used to evaluate publication bias. The bivariate random-effect model was used for calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC). A Fagan nomogram was applied to evaluate the clinical applicability of the A2DS2 scale. Results A total of 29 full-text articles met the inclusion criteria, including 19,056 patients. Bivariate mixed-effects regression models yielded a mean sensitivity of 0.78 (95 % CI: 0.73–0.83), a specificity of 0.79 (95 % CI: 0.73–0.84), a positive likelihood ratio of 3.7 (95 % CI: 2.9–4.6), and a negative likelihood ratio of 0.27 (95 % CI: 0.23–0.33). The area under the receiver operating characteristic curve was 0.85 (95 % CI: 0.82–0.88). If given a pre-test probability of 50 %, the Fagan nomogram showed that when A2DS2 was positive, the post-test probability improved to 79 %. In contrast, when A2DS2 was negative, it decreased to 22 %. The results of the subgroup analysis showed no effect on the diagnostic accuracy of the A2DS2 scale in predicting stroke-associated pneumonia, except for the optimal cut-off value. Conclusions The A2DS2 scale demonstrates high clinical applicability and could be a valid scale for the early prediction of stroke-associated pneumonia in stroke patients.

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Salivary DNA Methylation as an Epigenetic Biomarker for Head and Neck Cancer. Part I: A Diagnostic Accuracy Meta-Analysis

Journal of Personalized Medicine ◽

10.3390/jpm11060568 ◽

2021 ◽

Vol 11 (6) ◽

pp. 568

Author(s):

Óscar Rapado-González ◽

Cristina Martínez-Reglero ◽

Ángel Salgado-Barreira ◽

Laura Muinelo-Romay ◽

Juan Muinelo-Lorenzo ◽

...

Keyword(s):

Dna Methylation ◽

Head And Neck Cancer ◽

Diagnostic Accuracy ◽

Head And Neck ◽

Likelihood Ratio ◽

Neck Cancer ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Epigenetic Mechanism ◽

Cochrane Library

DNA hypermethylation is an important epigenetic mechanism for gene expression inactivation in head and neck cancer (HNC). Saliva has emerged as a novel liquid biopsy representing a potential source of biomarkers. We performed a comprehensive meta-analysis to evaluate the overall diagnostic accuracy of salivary DNA methylation for detecting HNC. PubMed EMBASE, Web of Science, LILACS, and the Cochrane Library were searched. Study quality was assessed by the Quality Assessment for Studies of Diagnostic Accuracy-2, and sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (dOR), and their corresponding 95% confidence intervals (CIs) were calculated using a bivariate random-effect meta-analysis model. Meta-regression and subgroup analyses were performed to assess heterogeneity. Eighty-four study units from 18 articles with 8368 subjects were included. The pooled sensitivity and specificity of salivary DNA methylation were 0.39 and 0.87, respectively, while PLR and NLR were 3.68 and 0.63, respectively. The overall area under the curve (AUC) was 0.81 and the dOR was 8.34. The combination of methylated genes showed higher diagnostic accuracy (AUC, 0.92 and dOR, 36.97) than individual gene analysis (AUC, 0.77 and dOR, 6.02). These findings provide evidence regarding the potential clinical application of salivary DNA methylation for HNC diagnosis.

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Qualitative Alpha-defensin Versus The Main Available Tests For The Diagnosis Of Periprosthetic Joint Infection: Best Predictor Test?

Journal of Bone and Joint Infection ◽

10.7150/jbji.26401 ◽

2018 ◽

Vol 3 (3) ◽

pp. 156-164 ◽

Cited By ~ 11

Author(s):

Giovanni Riccio ◽

Luca Cavagnaro ◽

Wassim Akkouche ◽

Giuliana Carrega ◽

Lamberto Felli ◽

...

Keyword(s):

Likelihood Ratio ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Methods ◽

Minimal Amount ◽

Musculoskeletal Infection ◽

Infection Diagnosis ◽

Significant Difference

Abstract. Introduction: Biomarkers such as α-defensin demonstrated to be a potentially useful option in periprosthetic joint infection (PJI) diagnosis. Recently, a new point-of-care test for α-defensin level detection in synovial fluid has been commercialized in Europe. The aim of this study is to compare the α-defensin test (SynovasureTM) diagnostic ability with the main available clinical tests for periprosthetic joint infection diagnosis in a practical clinical setting of a Bone Infection Unit.Methods: Between 2015 and 2017, 146 patients with suspected chronic PJI were screened with SynovasureTM. Seventy-three of these met the Musculoskeletal Infection Society (MSIS) criteria and were included in the analysis. According to MSIS criteria, 40 patients (54.7%) were classified as infected and 33 (45.3%) as not infected. The results obtained with SynovasureTM were recorded and compared with standard diagnostic methods for PJI diagnosis.Results: SynovasureTM showed a sensitivity of 85.0 % (95% CI 70.2 to 94.3) and a specificity of 96.9 % (95% CI 83.8 to 99.9) for PJI detection. The positive likelihood ratio of SynovasureTM was 27.2 (95% CI 3.9 to 188.1) and the negative likelihood ratio was 0.2 (95% CI 0.1 to 0.3). The diagnostic odds ratio was 181.3 (95% CI 20.7 to 1590.4). SynovasureTM demonstrated a statistical significant difference when compared to Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) specificity (at least one positive test) and preoperative culture sensitivity (1 positive culture).Conclusion: Our findings show that SynovasureTM sensitivity is lower than quantitative α-D test, but when compared to the main available tests shows a good specificity and the highest DOR. On the SF it is the easier test to do, due to the fact that it needs a minimal amount of SF and it is not limited by blood contamination or antibiotic use. Whereas there is no single standalone test, SynovasureTM should be considered a reliable additional test for periprosthetic joint infection diagnosis in everyday clinical practice.

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Diagnostic accuracy of transthoracic echocardiography for pulmonary hypertension: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-033084 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033084 ◽

Cited By ~ 1

Author(s):

Jin-Rong Ni ◽

Pei-Jing Yan ◽

Shi-Dong Liu ◽

Yuan Hu ◽

Ke-Hu Yang ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Hypertension ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Transthoracic Echocardiography ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Cochrane Library ◽

Lower Sensitivity ◽

Time Interval

ObjectiveTo evaluate the diagnostic accuracy of transthoracic echocardiography (TTE) in patients with pulmonary hypertension (PH).DesignSystematic review and meta-analysis.Data sources and eligibility criteriaEmbase, Cochrane Library for clinical trials, PubMed and Web of Science were used to search studies from inception to 19 June, 2019. Studies using both TTE and right heart catheterisation (RHC) to diagnose PH were included.Main resultsA total of 27 studies involving 4386 subjects were considered as eligible for analysis. TTE had a pooled sensitivity of 85%, a pooled specificity of 74%, a pooled positive likelihood ratio of 3.2, a pooled negative likelihood ratio of 0.20, a pooled diagnostic OR of 16 and finally an area under the summary receiver operating characteristic curve of 0.88. The subgroup with the shortest time interval between TTE and RHC had the best diagnostic effect, with sensitivity, specificity and area under the curve (AUC) of 88%, 90% and 0.94, respectively. TTE had lower sensitivity (81%), specificity (61%) and AUC (0.73) in the subgroup of patients with definite lung diseases. Subgroup analysis also showed that different thresholds of TTE resulted in a different diagnostic performance in the diagnosis of PH.ConclusionTTE has a clinical value in diagnosing PH, although it cannot yet replace RHC considered as the gold standard. The accuracy of TTE may be improved by shortening the time interval between TTE and RHC and by developing an appropriate threshold. TTE may not be suitable to assess pulmonary arterial pressure in patients with pulmonary diseases.PROSPERO registration numberPROSPERO CRD42019123289.

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The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01726-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jian Yao ◽

Tao Bai ◽

Bo Yang ◽

Lizhong Sun

Keyword(s):

Aortic Dissection ◽

Likelihood Ratio ◽

Acute Aortic Dissection ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Diagnostic Value ◽

Cochrane Library ◽

Operating Characteristics ◽

Meta Regression ◽

D Dimer

Abstract Objective This study aims to evaluate the diagnostic value of D-dimer for acute aortic dissection (AAD) by the method of meta-analysis. Methods PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases from the establishment of the databases to December 2020 were systematically searched, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) system was used to evaluate the quality of the literature. STATA 15.0 software was applied to calculate the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (+LR), negative likelihood ratio (−LR) to draw summary receiver operating characteristics (SROC) curve and calculate the area under the curve (AUC). Meta-regression and subgroup analyses were used to explore the source of heterogeneity. Results A total of 16 clinical studies were enrolled in this study, including 1135 patients. The results of the meta-analysis showed that the pooled sensitivity was 0.96 (95% CI 0.91–0.98), the pooled specificity was 0.70 (95% CI 0.57–0.81), and the pooled DOR was 56.57 (95% CI 25.11–127.44), the pooled +LR was 3.25 (95% CI 2.18–4.85), the pooled −LR was 0.06 (95% CI 0.03–0.12), and the AUC was 0.94 (95% CI 0.91–0.95). Meta-regression and subgroup analysis results showed that publication year, sample size and cutoff value might be sources of heterogeneity. When the concentration of D-dimer was less than or equal to 500 ng/ml, the sensitivity significantly increased. Conclusion D-dimer has an excellent diagnostic value for AAD. It is a useful tool for detecting suspected AAD because of the excellent pooled sensitivity. D-dimer ≤ 500 ng/ml increases the potential to identify the suspected patients with AAD.

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