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Published on: December 3, 2017
Different diagnostic performance of plasma fibrinogen and D-dimer in periprosthetic joint infection: a propensity
Xi Chen1, Wenwei Qian2, Xisheng Weng1
1Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Background:
Fibrinogen (Fbg) and D-dimer have been used as biomarkers for the diagnosis of periprosthetic joint infection (PJI). However, previous research has reported conflicting results on the diagnostic value of D-dimer in comparison to Fbg, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
Aim:
This study aimed to: (1) determine the optimal threshold of plasma Fbg and D-dimer in the diagnosis of PJI and compare their diagnostic value to that of CRP and ESR; and (2) investigate whether Fbg and D-dimer perform differently than CRP and ESR as diagnostic indicators for different types of PJI.
Methods:
A total of 115 revision cases after total hip arthroplasty (THA) and total knee arthroplasty (TKA) were identified. Based on demographic characteristics, 25 culture-positive cases were matched to 50 culture-negative cases using propensity score matching. Sensitivity, specificity, receiver operating characteristics (ROC), negative predictive value (NPV), and positive predictive value (PPV) were calculated and compared.
Results:
The optimal thresholds were 2.72 mg/L for D-dimer, 3.655 g/L for Fbg, 12.64 mg/L for CRP, and 27 mm/h for ESR. Levels of plasma Fbg, D-dimer, CRP, and ESR were significantly higher in the culture-positive group than the culture-negative group. Fbg, D-dimer, CRP, and ESR showed sensitivity of 0.92, 0.56, 0.92, and 0.88, respectively, and showed specificity of 0.84, 0.96, 0.94, and 0.80, respectively. The ROC curve showed that CRP has the highest area under the curve (AUC) (0.94), followed by Fbg (0.90), ESR (0.87), and D-dimer (0.81).
Conclusions:
Plasma Fbg exhibited a similar diagnostic performance compared to CRP and ESR in predicting culture-positive results in PJI. Plasma D-dimer showed high specificity but low sensitivity. In our study, Fbg and D-dimer did not show better diagnostic performance with different pathogens and different types of PJI. Further studies are required to investigate the difference between serum D-dimer and plasma D-dimer in the arthroplasty population.
Insights
Fibrinogen (Fbg) and C-reactive protein (CRP) show similar diagnostic performance for periprosthetic joint infection (PJI). D-dimer offers high specificity but low sensitivity for PJI diagnosis.
Area of Science:
- Orthopedics
- Biomarkers
- Infectious Diseases
Background:
- Fibrinogen (Fbg) and D-dimer are utilized as biomarkers for diagnosing periprosthetic joint infection (PJI).
- Previous studies present conflicting data regarding the diagnostic utility of D-dimer compared to Fbg, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
Purpose of the Study:
- Determine optimal plasma thresholds for Fbg and D-dimer in PJI diagnosis.
- Compare the diagnostic value of Fbg and D-dimer against CRP and ESR.
- Investigate differential performance of Fbg and D-dimer in various PJI types.
Main Methods:
- Analysis of 115 revision cases after total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- Propensity score matching of 25 culture-positive to 50 culture-negative cases.
- Calculation and comparison of sensitivity, specificity, ROC, NPV, and PPV.
Main Results:
- Optimal thresholds: D-dimer 2.72 mg/L, Fbg 3.655 g/L, CRP 12.64 mg/L, ESR 27 mm/h.
- Significantly higher levels of Fbg, D-dimer, CRP, and ESR in culture-positive PJI cases.
- Diagnostic performance (sensitivity, specificity): Fbg (0.92, 0.84), D-dimer (0.56, 0.96), CRP (0.92, 0.94), ESR (0.88, 0.80).
- Area Under Curve (AUC) for ROC: CRP (0.94), Fbg (0.90), ESR (0.87), D-dimer (0.81).
Conclusions:
- Plasma Fbg demonstrates comparable diagnostic performance to CRP and ESR for culture-positive PJI.
- Plasma D-dimer exhibits high specificity but limited sensitivity in PJI diagnosis.
- Fbg and D-dimer did not show improved diagnostic performance across different PJI types or pathogens.
