Plasma levels of D-dimer and fibrin degradation product are unreliable for diagnosing periprosthetic joint infection in patients undergoing re-revision arthroplasty.
D-dimer
Diagnosis
Fibrin degradation product
Periprosthetic joint infection
Plasma
Re-revision arthroplasty
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
19 Oct 2021
19 Oct 2021
Historique:
received:
16
08
2021
accepted:
30
09
2021
entrez:
20
10
2021
pubmed:
21
10
2021
medline:
28
1
2022
Statut:
epublish
Résumé
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. 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. 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%. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 34666806
doi: 10.1186/s13018-021-02764-0
pii: 10.1186/s13018-021-02764-0
pmc: PMC8524877
doi:
Substances chimiques
Biomarkers
0
Fibrin Fibrinogen Degradation Products
0
Interleukin-6
0
fibrin fragment D
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
628Subventions
Organisme : West China Hospital, Sichuan University
ID : ZYJC18039
Informations de copyright
© 2021. The Author(s).
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