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The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis

Giovanni Balato1, Cristiano De Franco1, Fiamma Balboni2

  • 1Department of Public Health, Orthopedic Unit, Federico II University Naples, Naples, Italy.

Diagnosis (Berlin, Germany)
|May 20, 2021
PubMed
Abstract

Insights

D-dimer shows good accuracy for ruling out periprosthetic joint infection (PJI). This meta-analysis found sufficient diagnostic value, though blood sample type may affect results.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Periprosthetic joint infection (PJI) diagnosis lacks definitive evidence regarding D-dimer accuracy.
  • Contradictory findings necessitate a comprehensive review of D-dimer's diagnostic utility in PJI.

Purpose of the Study:

  • To critically evaluate and synthesize the diagnostic accuracy of D-dimer for PJI detection.
  • To provide a meta-analysis summarizing D-dimer's performance in diagnosing PJI.

Main Methods:

  • A systematic literature search was conducted across MEDLINE, Scopus, and Web of Science.
  • Bivariate random-effects modeling was used to analyze sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR).
  • Study quality was assessed using QUADAS, and heterogeneity was explored via subgroup analysis and meta-regression.

Main Results:

  • The meta-analysis included 12 studies with 1,818 patients (539 with PJI).
  • Pooled sensitivity was 0.739 and specificity was 0.785, with an area under the ROC curve (AUC-ROC) of 0.688.
  • The diagnostic odds ratio (DOR) was 11.787, suggesting moderate diagnostic accuracy.

Conclusions:

  • D-dimer demonstrates sufficient accuracy to help rule out PJI.
  • Blood sample type (plasma vs. serum) and study design may influence diagnostic accuracy (DOR and sensitivity).
  • Further prospective studies are recommended to confirm the diagnostic utility of D-dimer in PJI.
Keywords:
D-dimerarthroplastydiagnosisperiprosthetic joint infection

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