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Diagnostic Accuracy of Rotational Thromboelastometry for Low-Virulence Periprosthetic Joint Infections: A Pilot Study
Andreas G Tsantes1,2, Aglaia Domouchtsidou2, Konstantina A Tsante1
1Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Background:
Periprosthetic joint infections (PJIs) are associated with altered coagulation dynamics; therefore, coagulation laboratory studies could be valuable for diagnosing PJI. This study aimed to evaluate the diagnostic role of Rotational Thromboelastometry (ROTEM) in detecting PJIs caused by low-virulence pathogens.
Methods:
A retrospective study was conducted, enrolling 78 patients who underwent exchange arthroplasty due to PJI due to high-virulence pathogens (Group A, n = 16), low-virulence pathogens (Group B, n = 20), or due to aseptic loosening (Group C, n = 20). Preoperative laboratory findings were compared among the three groups.
Results:
Several ROTEM parameters differed in patients with PJIs caused by low-virulence pathogens, indicating a link between these infections and hypercoagulability. The development of low-virulence PJIs was associated with a higher maximum clot firmness (MCF) (Odds Ratio, 1.12; 95% Confidence Interval, 1.04-1.21; p = 0.001). Additionally, EXTEM MCF was found to have the highest diagnostic accuracy for these infections (Area Under the Curve, 0.841; sensitivity 90.0%; specificity 90.4%), surpassing that of C-reactive protein and the Erythrocyte Sedimentation Rate (p = 0.006 and p = 0.019, respectively).
Conclusions:
Our findings suggest that ROTEM analysis is a promising method for detecting the altered hemostatic dynamics associated with PJI caused by low-virulence pathogens.
Insights
Rotational Thromboelastometry (ROTEM) shows promise in diagnosing periprosthetic joint infections (PJIs) caused by low-virulence pathogens. This coagulation test effectively identifies hypercoagulability, aiding in PJI detection.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Hematology
Background:
- Periprosthetic joint infections (PJIs) present diagnostic challenges, particularly those caused by low-virulence pathogens.
- Altered coagulation dynamics are observed in PJIs, suggesting the utility of coagulation laboratory studies.
Purpose of the Study:
- To evaluate the diagnostic role of Rotational Thromboelastometry (ROTEM) in detecting PJIs caused by low-virulence pathogens.
- To compare the diagnostic accuracy of ROTEM parameters with established inflammatory markers.
Main Methods:
- A retrospective study involving 78 patients undergoing exchange arthroplasty.
- Patients were categorized into three groups: high-virulence PJI, low-virulence PJI, and aseptic loosening.
- Preoperative laboratory findings, including ROTEM parameters, were analyzed.
Main Results:
- ROTEM analysis revealed altered hemostatic dynamics in patients with low-virulence PJIs, indicating hypercoagulability.
- Higher maximum clot firmness (MCF) was significantly associated with low-virulence PJI development.
- EXTEM MCF demonstrated superior diagnostic accuracy (AUC 0.841) compared to C-reactive protein and Erythrocyte Sedimentation Rate.
Conclusions:
- ROTEM analysis is a valuable tool for detecting altered hemostatic dynamics in PJIs caused by low-virulence pathogens.
- The findings support ROTEM as a promising diagnostic method for specific PJI cases.
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