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Plasma fibrinogen may predict persistent infection before reimplantation in two-stage exchange arthroplasty for
Chi Xu1, Peng-Fei Qu1, Wei Chai1
1Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
Background:
The diagnosis of persistent infection before reimplantation in two-stage exchange arthroplasty for periprosthetic joint infection (PJI) remains challenging. Currently, several studies suggested coagulation-related markers, such as D-dimer and fibrinogen, may be promising in diagnose of PJI. The purpose of the study was to investigate the predictive values of plasma D-dimer and fibrinogen for assessment of persistent infection before reimplantation hip arthroplasty.
Methods:
We retrospectively reviewed 129 hips that treated with two-stage exchange arthroplasty for PJI from 2012 to 2016 in our institution. The persistent infection before reimplantation was based on a modified Musculoskeletal Infection Society (MSIS) criteria. After exclusion, 102 hips were included in the final analysis. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of plasma D-dimer and fibrinogen in predicting persistent infection before reimplantation.
Results:
The area the under ROC curves (AUC) for fibrinogen (0.773; 95% confidential interval [CI], 0.569-0.905) was significantly higher than that of D-dimer (0.565; 95% CI, 0.329-0.777). With the calculated threshold of fibrinogen set at 3.61 g/L, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5%, 62.8%, 16.7%, and 98.3%, respectively. With the threshold value of D-dimer set at 0.82 μg/mL, the sensitivity, specificity, PPV, and NPV was 83.3%, 41.9%, 21.7%, and 92.9%, respectively.
Conclusions:
In conclusion, the current study reveals that the plasma fibrinogen may be a promising biomarker in predicting persistent infection before reimplantation. Further prospective studies with larger cohorts are needed to validate predictive values and optimal thresholds of coagulation-related markers.
Insights
Plasma fibrinogen shows promise in diagnosing persistent periprosthetic joint infection (PJI) before reimplantation surgery. This coagulation marker demonstrated higher predictive value than D-dimer, aiding in infection assessment.
Area of Science:
- Orthopedic surgery
- Infectious disease diagnostics
- Biomarker research
Background:
- Diagnosing persistent periprosthetic joint infection (PJI) before reimplantation in two-stage exchange arthroplasty is challenging.
- Coagulation markers like D-dimer and fibrinogen are being investigated for their potential in PJI diagnosis.
Purpose of the Study:
- To evaluate the predictive value of plasma D-dimer and fibrinogen for identifying persistent infection before hip arthroplasty reimplantation.
Main Methods:
- Retrospective review of 102 hips treated for PJI between 2012 and 2016.
- Persistent infection diagnosis based on modified Musculoskeletal Infection Society (MSIS) criteria.
- Receiver operating characteristic (ROC) curve analysis to assess prognostic values of D-dimer and fibrinogen.
Main Results:
- Fibrinogen demonstrated a significantly higher area under the ROC curve (0.773) compared to D-dimer (0.565).
- At a threshold of 3.61 g/L, fibrinogen achieved 87.5% sensitivity and 62.8% specificity for persistent infection.
- D-dimer at 0.82 μg/mL showed 83.3% sensitivity and 41.9% specificity.
Conclusions:
- Plasma fibrinogen appears to be a promising biomarker for predicting persistent infection before reimplantation in hip arthroplasty.
- Further prospective studies with larger patient cohorts are necessary to validate these findings and establish optimal thresholds.
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