Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of

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Liping Pan1, Hao Wu1, Heng Liu1

  • 1Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, XiCheng District, Beijing, 100034, People's Republic of China.

Journal of Orthopaedic Surgery and Research
|January 10, 2021
PubMed
Abstract

Insights

Fibrinogen demonstrates higher specificity than D-dimer for diagnosing periprosthetic joint infection (PJI). This meta-analysis indicates fibrinogen is a more reliable rule-in diagnostic marker for PJI, though further trials are recommended.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Periprosthetic joint infection (PJI) diagnosis remains challenging.
  • Coagulation parameters like D-dimer and fibrinogen have shown potential but controversial utility.
  • This study synthesizes evidence to compare their diagnostic accuracy for PJI.

Purpose of the Study:

  • To compare the diagnostic accuracies of D-dimer and fibrinogen for periprosthetic joint infection (PJI).
  • To evaluate their performance as diagnostic tools for PJI using meta-analysis.

Main Methods:

  • A comprehensive literature search was conducted across major databases (Cochrane, MEDLINE, Web of Science, Embase) up to March 2020.
  • Eleven studies were included in the meta-analysis, evaluating pooled sensitivity, specificity, and likelihood ratios.
  • Diagnostic performance differences between D-dimer and fibrinogen were analyzed using Z test statistics.

Main Results:

  • Fibrinogen showed a pooled specificity of 0.85 and a positive likelihood ratio of 5.12 for PJI.
  • D-dimer had a pooled sensitivity of 0.79 and a specificity of 0.77.
  • Fibrinogen's specificity was significantly higher than D-dimer's (p=0.03), indicating better rule-in performance.

Conclusions:

  • Fibrinogen performs better than D-dimer as a rule-in diagnostic tool for PJI due to its significantly higher specificity.
  • While fibrinogen shows promise, further large-scale prospective trials are necessary for definitive confirmation.
  • This meta-analysis provides valuable insights into the diagnostic utility of coagulation markers in PJI.
Keywords:
D-dimerDiagnosisFibrinogenMeta-analysisPeriprosthetic joint infection

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