The Accuracy of D-dimer in the Diagnosis of Periprosthetic Infections: a Systematic Review and Meta-analysis

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2022 Feb 17

PMID 35172830

Authors

Renwei Wang

Hui Zhang

Peng Ding

Qiang Jiao

Affiliations

Soon will be listed here.

Abstract

Background: Periprosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA) or total knee arthroplasty (TKA). It is scarce and contradicting evidence supporting the use of serum D-dimer to diagnose PJI in revision THA and TKA. This systematic review and meta-analysis aimed to investigate the accuracy of D-dimer in the diagnosis of periprosthetic infections.

Methods: The PubMed, Embase, Web of Science were systematically searched from the inception dates to August 15, 2020. We included all diagnostic studies of D-dimer in the diagnosis of periprosthetic infections. The literature's quality was evaluated by the QUADAS-2 tool, and Stata16 and Revman5.3 software carried out the meta-analysis.

Results: Of 115 citations identified by the search strategy, 10 studies (comprising 1756 participants) met the inclusion criteria. The literature quality assessment results show that most of the literature is low-risk bias literature. The combined sensitivity of D-dimer in diagnosing periprosthetic infections was 0.81 (95% confidence interval [CI] 0.71-0.88), combined specificity was 0.74 (95% CI 0.61-0.84), combined positive likelihood ratio was 3.1 (95% CI 2.0-5.0), combined negative likelihood ratio 0.26 (95% CI 0.16-0.41), combined diagnosis odds ratio 12 (95% CI 5-27), area under the Summary Receiver Operator Characteristic Curve (SROC) is 0.85 (95% CI 0.81-0.88). The data are statistically significant.

Conclusion: D-dimer has a high diagnostic value in diagnosing PJI and has clinical significance in diagnosing periprosthetic infection. In addition, there are relatively few studies on the threshold of D-dimer, different sampling types, different laboratory detection methods, and different races, so more prospective trials with large samples, multi-centers, and scientific design should be carried out in the future.

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