Role of D-dimer and Fibrinogen in the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2021 Mar 8

PMID 33682337

Citations 12

Authors

Hong Xu

Jin-Wei Xie

Jing-Li Yang

Ze-Yu Huang

Fu-Xing Pei

Affiliations

Soon will be listed here.

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.

Citing Articles

Periprosthetic joint infections: state-of-the-art.

Gehrke T, Citak M, Parvizi J, Budhiparama N, Akkaya M Arch Orthop Trauma Surg. 2024; 145(1):58.

PMID: 39694911 DOI: 10.1007/s00402-024-05627-5.

An overview of the current diagnostic approach to Periprosthetic Joint Infections.

Al-Jabri T, Ridha M, Wood M, Kayani B, Jayadev C, McCulloch R Orthop Rev (Pavia). 2024; 16:120308.

PMID: 38957745 PMC: 11218870. DOI: 10.52965/001c.120308.

Unreliability of Serum- or Plasma-based Assays of D-dimer or Fibrin (Fibrinogen) Degradation Product for Diagnosing Periprosthetic Joint Infection: A Prospective Parallel Study.

Xu H, Zhou J, Huang Q, Huang Z, Xie J, Zhou Z Orthop Surg. 2023; 16(1):29-37.

PMID: 37975182 PMC: 10782268. DOI: 10.1111/os.13935.

Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023.

Yilmaz M, Abbaszadeh A, Tarabichi S, Azboy I, Parvizi J Antibiotics (Basel). 2023; 12(6).

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Utility of D-dimer in total joint arthroplasty.

Cutter B, Lum Z, Giordani M, Meehan J World J Orthop. 2023; 14(3):90-102.

PMID: 36998388 PMC: 10044320. DOI: 10.5312/wjo.v14.i3.90.

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