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D-Dimer, Erythrocyte Sedimentation Rate, and C-Reactive Protein Sensitivities for Periprosthetic Joint Infection
Colleen M Wixted1, Lefko T Charalambous1, Billy I Kim1
1Duke University School of Medicine, Durham, North Carolina.
Background:
There is contradicting evidence on the diagnostic value of inflammatory biomarkers for periprosthetic joint infection (PJI). We sought to quantify the sensitivity of D-dimer for acute and chronic PJI diagnosis and evaluate D-dimer lab values in the 90-day postoperative window in a control cohort of primary joint arthroplasty patients for comparison.
Methods:
An institutional database was queried for patients undergoing revision procedures for PJI after total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2014 to present. CRP, ESR, and D-dimer were collected within 90 days pre and postoperatively and sensitivities for the diagnosis of PJI were calculated. The control group included patients who underwent a negative diagnostic workup for deep venous thrombosis (DVT) or pulmonary embolus (PE) and had a D-dimer lab collected within 90 days postoperatively from primary total joint arthroplasty (TJA).
Results:
A total of 604 PJI patients were identified, and 81 patients had D-dimer, ESR, and CRP collected. There were 50/81 acute PJI patients and 31/81 chronic PJI patients who had median D-dimer values of 2,136.5 ng/mL [interquartile range (IQR): 1,642-3,966.5] and 3,336 ng/mL [IQR: 1,976-5,594]. Only the chronic PJI group had significantly higher D-dimer values when compared to the control cohort (P = .009). The sensitivity of D-dimer was calculated to be 92% and 93.5% in the acute and chronic PJI groups, respectively.
Conclusion:
Serum D-dimer may not have high diagnostic utility for acute PJI, especially in the setting of recent surgery; however, it still may be useful for patients who have chronic PJI.
Insights
D-dimer shows high sensitivity for diagnosing periprosthetic joint infection (PJI), particularly chronic PJI. While less reliable for acute PJI post-surgery, D-dimer may still aid in diagnosing chronic cases.
Area of Science:
- Orthopedics
- Infectious Diseases
- Laboratory Medicine
Background:
- Contradictory evidence exists regarding the diagnostic value of inflammatory biomarkers for periprosthetic joint infection (PJI).
- The role of D-dimer in diagnosing acute and chronic PJI requires further clarification.
- Evaluating D-dimer levels in the early postoperative period is crucial for understanding its utility.
Purpose of the Study:
- To quantify the diagnostic sensitivity of D-dimer for acute and chronic PJI.
- To compare D-dimer lab values in PJI patients with a control cohort of primary joint arthroplasty patients.
- To assess D-dimer's utility within the 90-day postoperative window.
Main Methods:
- Retrospective query of an institutional database for PJI revision cases (total hip arthroplasty and total knee arthroplasty).
- Collection of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) within 90 days pre/postoperatively.
- Comparison with a control group of primary total joint arthroplasty patients with negative deep venous thrombosis/pulmonary embolism workup.
Main Results:
- 604 PJI patients identified; 81 had complete D-dimer, ESR, and CRP data.
- Median D-dimer levels were 2,136.5 ng/mL for acute PJI and 3,336 ng/mL for chronic PJI.
- Chronic PJI group showed significantly higher D-dimer than controls (P=.009); sensitivities were 92% (acute) and 93.5% (chronic).
Conclusions:
- Serum D-dimer may lack high diagnostic utility for acute PJI, especially soon after surgery.
- D-dimer may still be a valuable biomarker for diagnosing chronic PJI.
- Further research is needed to define D-dimer's precise role in PJI diagnosis.
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