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Circulating D-Dimer versus Fibrinogen in the Diagnosis of Peri-Prosthetic Joint Infection: A Meta-Analysis

Qingyu Zhang1, Jinlei Dong1, Dongsheng Zhou1

  • 1Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, Shandong, China.

Surgical Infections
|April 30, 2020
PubMed

Insights

Plasma fibrinogen is an excellent biomarker for diagnosing peri-prosthetic joint infection (PJI), comparable to CRP and ESR. Circulating D-dimer shows only moderate diagnostic value for PJI, requiring further large-scale studies.

Area of Science:

  • Orthopedics
  • Biomarkers
  • Diagnostic Accuracy

Background:

  • Peri-prosthetic joint infection (PJI) diagnosis relies on various biomarkers.
  • Circulating D-dimer and fibrinogen are emerging as potential diagnostic markers for PJI.
  • Their comparative clinical utility remains under investigation.

Purpose of the Study:

  • To evaluate and compare the diagnostic accuracy of circulating D-dimer and fibrinogen for suspected PJI.
  • To synthesize existing evidence through a meta-analysis.

Main Methods:

  • Comprehensive literature search in PubMed, EMBASE, and Cochrane Library up to August 1, 2019.
  • Inclusion of diagnostic accuracy studies investigating D-dimer or fibrinogen in PJI.
  • Meta-analysis to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC).

Main Results:

  • Seven studies with 1,374 patients were included.
  • Both D-dimer and fibrinogen levels were significantly higher in PJI patients.
  • Plasma fibrinogen demonstrated higher sensitivity (0.84) and specificity (0.80) than D-dimer (sensitivity 0.74, specificity 0.66).
  • Pooled AUC for fibrinogen (0.87) and CRP (0.87) were higher than for D-dimer (0.84) and ESR (0.82).

Conclusions:

  • Plasma fibrinogen is an excellent biomarker for PJI diagnosis, comparable to CRP and ESR.
  • Circulating D-dimer has a moderate diagnostic value for PJI.
  • Further large-scale, prospective studies are warranted to validate these findings.
Keywords:
D-dimerfibrinogenmeta-analysisperi-prosthetic joint infection

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