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Xu H, Zhou J, Huang Q, Huang Z, Xie J, Zhou Z. Unreliability of Serum- or Plasma-based Assays of D-dimer or Fibrin (Fibrinogen) Degradation Product for Diagnosing Periprosthetic Joint Infection: A Prospective Parallel Study. Orthop Surg 2024; 16:29-37. [PMID: 37975182 PMCID: PMC10782268 DOI: 10.1111/os.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The ability of D-dimer to diagnose periprosthetic joint infection (PJI) before revision hip or knee arthroplasty is still controversial, and the differences in diagnostic ability between serum- or plasma-based assays of D-dimer and fibrin (fibrinogen) degradation product (FDP) are uncertain. The prospective parallel study was performed to determine the ability of D-dimer to diagnose PJI before revision hip or knee arthroplasty, and the differences in diagnostic ability between serum- or plasma-based assays of D-dimer and FDP. METHODS Patients undergoing knee or hip arthroplasty at our institution were prospectively enrolled into the following groups: those without inflammatory diseases who were undergoing primary arthroplasty ("Prim" group), those with inflammatory arthritis who were undergoing primary arthroplasty ("Prim/Inflam"), those undergoing revision arthroplasty because of aseptic failure ("Rev/Asept"), or those undergoing revision arthroplasty because of PJI ("Rev/PJI"). The ability of preoperative levels of D-dimer or FDP in serum or plasma to diagnose PJI in each group was assessed using areas under receiver operating characteristic curves (AUCs) and other diagnostic performance indicators. The diagnostic performance of these assays was compared with that of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). RESULTS In the final analysis, Prim included 42 patients; Prim/Inflam, 40; Rev./Asept, 62; and Rev./PJI, 47. D-dimer assays led to AUCs of 0.635 in serum and 0.573 in plasma, compared to 0.593 and 0.607 for FDP. Even in combination with CRP or ESR, these assays failed to perform as well as the combination of CRP and ESR for diagnosing PJI. CONCLUSION Levels of D-dimer or FDP in serum or plasma, whether used alone or together with CRP or ESR, are unreliable for diagnosing PJI before revision arthroplasty.
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Affiliation(s)
- Hong Xu
- Department of Orthopedic surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Jing Zhou
- Department of Laboratory Medicine, West China HospitalSichuan UniversityChengduChina
| | - Qiang Huang
- Department of Orthopedic surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Zeyu Huang
- Department of Orthopedic surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Jinwei Xie
- Department of Orthopedic surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Zongke Zhou
- Department of Orthopedic surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Xu H, Xie J, Wang D, Huang Q, Huang Z, Zhou Z. Plasma levels of D-dimer and fibrin degradation product are unreliable for diagnosing periprosthetic joint infection in patients undergoing re-revision arthroplasty. J Orthop Surg Res 2021; 16:628. [PMID: 34666806 PMCID: PMC8524877 DOI: 10.1186/s13018-021-02764-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 02/08/2023] Open
Abstract
Background The preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis. Methods We retrospectively analyzed data on patients who underwent re-revision hip or knee arthroplasty at our institute during 2008–2020. Patients were stratified into those who experienced PJI or not, based on 2013 International Consensus Meeting Criteria. Plasma levels of D-dimer and FDP as well as levels of the traditional inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and interleukin-6 were compared between the groups. The ability of these biomarkers to diagnose PJI was assessed based on the area under the receiver operating characteristic (AUC) curve, for which predictive cut-offs were optimized based on the Youden index. Results Based on a cut-off of 0.80 mg/L, D-dimer gave an AUC of 0.595, high sensitivity of 85.7% but poor specificity of 47.8%. Based on a cut-off of 2.80 mg/L, FDP gave an AUC of 0.550, poor sensitivity of 56.5% and poor specificity of 52.9%. CRP, ESR and interleukin-6 showed much better diagnostic ability, with AUCs > 0.82. The combination of CRP and interleukin-6 gave an AUC of 0.877, high sensitivity of 91.7% and acceptable specificity of 78.3%. Conclusions Plasma levels of D-dimer and FDP may be inappropriate for diagnosing PJI in patients undergoing re-revision arthroplasty, whereas the combination of serum CRP and interleukin-6 may be effective.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jinwei Xie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Duan Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China.
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Xu H, Xie J, Zhou J, Wang X, Wang D, Huang Z, Zhou Z. Ability of plasma-based or serum-based assays of D-dimer and FDP for diagnosing periprosthetic joint infection: protocol for a prospective single-centre, parallel comparative study. BMJ Open 2021; 11:e046442. [PMID: 34215605 PMCID: PMC8256792 DOI: 10.1136/bmjopen-2020-046442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Several studies have evaluated the diagnostic values of D-dimer and fibrin degradation product (FDP) for detecting periprosthetic joint infection (PJI), but their conclusions have been inconsistent. More importantly, whether the diagnostic value of these two biomarkers differs depending on whether they are assayed in plasma or serum is unclear. METHODS AND ANALYSIS This prospective single-centre, parallel comparative study will involve patients planning to undergo revision hip or knee arthroplasty due to an aseptic mechanical failure or PJI. After the patients provide written informed consent, their serum and plasma will be sampled and assayed for D-dimer and FDP. The diagnostic value of these two biomarkers in plasma and serum will be compared with one another and with the value of two traditional inflammatory markers (C reactive protein and erythrocyte sedimentation rate) used to diagnose PJI according to the 2013 International Consensus Meeting criteria. Diagnostic value will be assessed in terms of area under receiver operating characteristic curves, sensitivity, specificity, as well as positive and negative predictive values, all calculated based on the optimal cut-off determined from the Youden index. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of our hospital (approval no. 2020-859). Written informed consent will be obtained from all patients before enrollment. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000038547), and it is ongoing.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jinwei Xie
- Department of Orthopaedic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jing Zhou
- Department of Laboratory Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Xing Wang
- Department of Orthopaedic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Duan Wang
- Department of Orthopaedic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Xu H, Shang G, Wang Y, Xiang S. Plasma fibrinogen is a reliable marker for diagnosing periprosthetic joint infection and determining the timing of second-stage revision. Int J Infect Dis 2021; 108:220-225. [PMID: 34089882 DOI: 10.1016/j.ijid.2021.05.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We investigated the diagnostic value of fibrinolytic markers for periprosthetic joint infection (PJI), determined their relationship with culture results, and evaluated whether these markers could assess infection control and determine the timing of second-stage reimplantation. DESIGN/METHODS This single-center-retrospective study included 206 patients who underwent revision hip or knee arthroplasty (PJI group, n = 79; aseptic loosening [AL] group, n = 127). The plasma levels of fibrinogen, d-dimer, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared, and receiver operating characteristic curves were constructed. Subgroup analysis within the PJI group was also performed. RESULTS The plasma levels of fibrinogen, d-dimer, ESR, and CRP were significantly lower in the AL group, with an area under the curve of 0.848, 0.669, 0.865, and 0.841, respectively. The plasma level of d-dimer was significantly lower in patients with culture-negative PJI. In patients with residual infection, the levels of all the markers had not significantly changed, while noticeably decreased plasma levels of fibrinogen, ESR, and CRP were detected in patients with successful second-stage reimplantation. CONCLUSIONS Plasma fibrinogen is a promising marker for diagnosing PJI and evaluating persistent infection. Decreased plasma levels of d-dimer in patients with PJI might be linked with negative culture results.
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Affiliation(s)
- Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangqian Shang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Xiang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Zhao D, He J, Wang X, Zhao X, Xia Y, Geng B. The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections. BMC Musculoskelet Disord 2021; 22:474. [PMID: 34030692 PMCID: PMC8146659 DOI: 10.1186/s12891-021-04357-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Fibrinogen (FIB) has been found to be a promising marker in diagnosing periprosthetic joint infection (PJI), however, the value of FIB in predicting reinfection of PJI is unknown. The purpose of this study was to evaluate the value of FIB in predicting reinfection after debridement, antibiotics, and implant retention (DAIR) for PJI. Methods We retrospectively analyzed the clinical data of patients who were diagnosed with PJI and underwent DAIR from 2013 to 2019. The levels of the FIB, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured before DAIR. After DAIR, patients were followed and reinfections were identified. For both acute and chronic PJI, the predictive value of FIB was evaluated by calculating the sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic curve (ROC), and was compared with traditional inflammatory markers including ESR and CRP. Results The expression of FIB differed between patients reinfected and those not reinfected in both acute and chronic PJI (p < 0.05). In patients who underwent DAIR for acute PJI, the sensitivity and specificity of FIB were 81.82 and 83.33%, respectively, which were significantly higher than that of CRP (sensitivity, 72.73%; specificity, 50%; p < 0.05), while the specificity was higher than that of ESR (specificity, 41.67%; p < 0.05). In patients who underwent DAIR for chronic PJI, the sensitivity and specificity of FIB were 80.00 and 66.66%, respectively, which were significantly higher than that of CRP (sensitivity, 53.33%; specificity, 66.66%; p < 0.05) and ESR (sensitivity was 66.00%; specificity, 16.66%; p < 0.05). The ROC curves showed that FIB demonstrated the highest AUC among the biomarkers in both acute and chronic PJI. Conclusion FIB is a promising indicator in predicting reinfection after DAIR for both acute and chronic PJI, and it seems to perform better than ESR and CRP. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04357-8.
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Affiliation(s)
- Dacheng Zhao
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, No. 82 of Cuiying Men, Lanzhou, 730030, Gansu, China
| | - Jinwen He
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, No. 82 of Cuiying Men, Lanzhou, 730030, Gansu, China
| | - Xingwen Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, No. 82 of Cuiying Men, Lanzhou, 730030, Gansu, China
| | - Xiaobing Zhao
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, No. 82 of Cuiying Men, Lanzhou, 730030, Gansu, China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, No. 82 of Cuiying Men, Lanzhou, 730030, Gansu, China.
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, No. 82 of Cuiying Men, Lanzhou, 730030, Gansu, China.
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A retrospective comparison of thromboelastography and conventional coagulation parameters for periprosthetic joint infection diagnosis and reimplantation timing. Clin Chim Acta 2021; 519:118-125. [PMID: 33895127 DOI: 10.1016/j.cca.2021.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The diagnostic significance of coagulation parameters in periprosthetic joint infection (PJI) is currently attracting increasing attention. We assessed the diagnostic accuracy of thromboelastography (TEG) for PJI and compared the values of various coagulation indicators for PJI diagnosis and reimplantation timing. METHODS We enrolled 250 patients undergoing revision for aseptic failure (Group A), revision for PJI (Group B), or reimplantation (Group C) during 2013-2020. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), representative coagulation-related indicators (reaction time [R], clotting time [K], angle and maximum amplitude [MA]) of TEG and routine coagulation indicators, including fibrinogen, D-dimer, fibrin degradation product (FDP), platelets count (PC), mean platelet volume (MPV), distribution width (PDW) and plateletcrit (PCT) as well as PC/MPV ratio(PVR)were measured preoperatively. Receiver operating characteristic (ROC) curves were used to evaluate the utility of all tested indicators for assessing infection. RESULTS All the indicators showed significant differences between groups A and B (P < 0.05) and, except for D-dimer, FDP, MPV and R, between groups B and C (P < 0.05). Similar differences were also observed in biomarkers before first-stage revision and second-stage reimplantation. ROC curves showed that fibrinogen, K, angle and MA outperformed the other coagulation indicators, with areas under the curve of 0.864 to 0.893 and threshold values of 3.55 g/L, 1.2 min, 72.4 deg and 69.1 mm, respectively. The multiple tests of TEG indices (K, angle and MA) and traditional inflammatory markers (CRP and ESR) or conventional coagulation indicators (fibrinogen, PC and PVR) had good sensitivity and specificity for PJI diagnosis, and the diagnostic values of TEG and platelet-associated indicators (PC and PVR) varied in the different subgroups. CONCLUSION TEG was closely related to PJI and could serve as a valuable technique for identifying residual infection before reimplantation. Fibrinogen showed high diagnostic accuracy for PJI and effectively guided the timing of reimplantation.
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Xu H, Xie JW, Yang JL, Huang ZY, Pei FX. Role of D-dimer and Fibrinogen in the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. Orthop Surg 2021; 13:692-700. [PMID: 33682337 PMCID: PMC8126916 DOI: 10.1111/os.12969] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jin-Wei Xie
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Li Yang
- College of Earth and Environmental Sciences, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ze-Yu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fu-Xing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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