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Published on: December 3, 2017
Plasma Fibrinogen and Platelet Count Are Referable Tools for Diagnosing Periprosthetic Joint Infection: A
Hong Xu1, Jinwei Xie1, Jingli Yang2
1Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Background:
Although the MusculoSkeletal Infection Society has suggested a series of markers to diagnose periprosthetic joint infection (PJI), no single marker can accurately identify infection before revision hip or knee arthroplasty, and exploring promising markers to easily and reliably diagnose PJI is ongoing. The aim of this study was to evaluate the diagnostic value of plasma fibrinogen and platelet count for diagnosing PJI.
Methods:
We retrospectively included 439 patients who underwent revision arthroplasty from January 2008 to December 2018; 79 patients with coagulation-related comorbidities were evaluated separately. The remaining 360 patients constituted 153 PJI and 207 non-PJI patients. Receiver operating characteristic curves were used to evaluate the maximum sensitivity and specificity of the tested markers.
Results:
The receiver operating characteristic curves showed that the areas under the curve for plasma fibrinogen, platelet count, and serum C-reactive protein and erythrocyte sedimentation rate were 0.834, 0.746, 0.887, and 0.842, respectively. Based on Youden's index, the optimal predictive cutoffs for fibrinogen and platelet count were 3.57 g/L and 221 × 109/L, respectively. The sensitivity and specificity, respectively, were 68.6% and 86.0% (fibrinogen) and 57.5% and 83.1% (platelet count) for diagnosing PJI. The sensitivity and specificity, respectively, were 76.7% and 72.2% (fibrinogen) and 48.8% and 63.9% (platelet count) for diagnosing PJI in patients with coagulation-related comorbidities.
Conclusion:
Plasma fibrinogen performed well for diagnosing PJI before revision arthroplasty, and its value neared that of traditional inflammatory markers. Although the diagnostic value of the platelet count was inferior to traditional markers, its diagnostic value was fair for diagnosing PJI. Fibrinogen also may be useful for diagnosing PJI in patients with coagulation-related comorbidities.
Insights
Plasma fibrinogen shows promise for diagnosing periprosthetic joint infection (PJI) before revision surgery, nearing the accuracy of traditional inflammatory markers. Platelet count also offers fair diagnostic value for PJI, even in patients with coagulation issues.
Area of Science:
- Orthopedics
- Infectious Diseases
- Hematology
Background:
- Diagnosing periprosthetic joint infection (PJI) before revision arthroplasty remains challenging.
- Current markers lack perfect accuracy, necessitating the exploration of novel diagnostic tools.
- The MusculoSkeletal Infection Society provides guidelines, but reliable pre-revision diagnostics are still sought.
Purpose of the Study:
- To evaluate the diagnostic utility of plasma fibrinogen and platelet count for PJI.
- To compare the efficacy of these markers against traditional inflammatory markers (CRP, ESR).
- To assess the diagnostic performance in patients with coagulation-related comorbidities.
Main Methods:
- Retrospective analysis of 439 patients undergoing revision arthroplasty (2008-2018).
- Exclusion of 79 patients with coagulation comorbidities for separate analysis.
- Utilized Receiver Operating Characteristic (ROC) curves to determine sensitivity and specificity.
Main Results:
- Plasma fibrinogen (AUC 0.834) and platelet count (AUC 0.746) were evaluated alongside CRP (AUC 0.887) and ESR (AUC 0.842).
- Optimal cutoffs: Fibrinogen 3.57 g/L (Sensitivity 68.6%, Specificity 86.0%), Platelet count 221 × 10^9/L (Sensitivity 57.5%, Specificity 83.1%).
- In patients with comorbidities, fibrinogen showed higher sensitivity (76.7%) and specificity (72.2%) than platelet count.
Conclusions:
- Plasma fibrinogen demonstrates significant diagnostic value for PJI, comparable to traditional inflammatory markers.
- Platelet count offers fair diagnostic capability for PJI, though less than traditional markers.
- Fibrinogen may be particularly useful for diagnosing PJI in patients with coagulation disorders.
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