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Role of D-dimer and Fibrinogen in the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and
Hong Xu1, Jin-Wei Xie1, Jing-Li Yang2
1Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Abstract:
The diagnostic potential of D-dimer and fibrinogen to detect periprosthetic joint infection (PJI) of the hip and knee is not well-understood. The aim of this study was to determine whether D-Dimer and fibrinogen can be used as effective biomarkers to screen PJI. A systematic review of the literature indexed in Web of Science, PubMed, Cochrane Library, Embase, and Google Scholar databases was performed. All studies using D-dimer levels in serum or plasma, or fibrinogen levels in plasma, for the diagnosis of PJI were included. Meta-analysis estimates, including sensitivity, specificity, diagnostic odds ratios (DOR), and the area under the summary receiver operating characteristic curve (AUSROC), were calculated using a random-effects model, and used to assess the diagnostic accuracy of these biomarkers. A total of nine studies were analyzed, and their quality was considered to be acceptable. D-dimer gave a limited diagnostic value if serum and plasma combined: sensitivity (0.77, 95% confidence interval [CI] [0.63 to 0.87]), specificity (0.67, 95% CI [0.54 to 0.78]), DOR (6.81, 95% CI [2.67 to 17.37]), and AUSROC (0.78, 95% CI [0.74 to 0.82]). Plasma D-dimer levels were associated with less satisfactory sensitivity (0.65, 95% CI 0.57 to 0.71), specificity (0.58, 95% CI 0.50 to 0.66), DOR (2.52, 95% CI 1.64 to 3.90), and AUSROC (0.65, 95% CI 0.61 to 0.69). Serum D-dimer levels showed higher corresponding values of 0.89 (95% CI 0.79 to 0.94), 0.76 (95% CI 0.55 to 0.89), 24.24 (95% CI 10.07 to 58.32), and 0.91 (95% CI 0.88 to 0.93). Plasma fibrinogen showed acceptable corresponding values of 0.79 (95% CI 0.70 to 0.85), 0.73 (95% CI 0.57 to 0.85), 10.14 (95% CI 6.16 to 16.70), and 0.83 (95% CI 0.79 to 0.86). Serum D-dimer may be an effective marker for the diagnosis of PJI in hip and knee arthroplasty patients, and it may show higher diagnostic potential than plasma fibrinogen. Plasma D-dimer may have limited diagnostic potential.
Insights
Serum D-dimer shows promise as a biomarker for diagnosing periprosthetic joint infection (PJI), outperforming plasma D-dimer and fibrinogen. This systematic review highlights serum D-dimer
Area of Science:
- Orthopedics
- Infectious Diseases
- Biomarkers
Background:
- Periprosthetic joint infection (PJI) diagnosis remains challenging.
- The utility of D-dimer and fibrinogen as diagnostic biomarkers for PJI is not well-established.
- Accurate and timely diagnosis of PJI is crucial for effective patient management.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of D-dimer and fibrinogen for PJI detection.
- To compare the diagnostic performance of serum D-dimer, plasma D-dimer, and plasma fibrinogen in identifying PJI.
Main Methods:
- Systematic literature search across major databases (Web of Science, PubMed, Cochrane Library, Embase, Google Scholar).
- Inclusion of studies evaluating serum/plasma D-dimer or plasma fibrinogen for PJI diagnosis.
- Meta-analysis of sensitivity, specificity, diagnostic odds ratios (DOR), and area under the summary receiver operating characteristic curve (AUSROC).
Main Results:
- Nine studies of acceptable quality were analyzed.
- Serum D-dimer demonstrated high diagnostic accuracy (AUSROC 0.91) for PJI.
- Plasma fibrinogen showed acceptable accuracy (AUSROC 0.83), while combined or plasma D-dimer had limited diagnostic value (AUSROC 0.78 and 0.65, respectively).
Conclusions:
- Serum D-dimer is a potentially effective biomarker for diagnosing PJI in hip and knee arthroplasty.
- Serum D-dimer may offer superior diagnostic potential compared to plasma fibrinogen and plasma D-dimer.
- Further research may validate serum D-dimer as a reliable PJI screening tool.
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