Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

December 29, 2019 at 1:58 pm

Journal of Arthroplasty January 2020 V.35  N.1  P.229–234

Background

Diagnosis of chronic periprosthetic joint infection (PJI) can be challenging and elusive in the absence of a gold standard. D-dimer plays an important role in inflammation that occurs during infections and therefore could be a valuable biomarker for PJI. This study aims to investigate the sensitivity and specificity of D-dimer in detecting chronic PJI and to improve the accuracy of chronic PJI diagnosis through combined measurement of serum D-dimer with C-reactive protein (CRP)/erythrocyte sedimentation rate.

Methods

One hundred twenty-two patients presenting with a painful knee or hip after total hip or total knee arthroplasty for surgical revision were included in this prospective trial. Our cohort consisted of 55 patients undergoing revision for chronic PJI and 67 patients undergoing revision for aseptic failure. PJI was defined using the Musculoskeletal Infection Society criteria. Receiver operating characteristic curves and area under the curve were analyzed for each biomarker.

Results

The area under the curve for D-dimer was 0.915 and was more accurate than serum erythrocyte sedimentation rate 0.719 and CRP 0.761. 1170 ng/mL was determined to be the optimal threshold value of D-dimer for the diagnosis of chronic PJI, with a sensitivity of 92.73% and a specificity of 74.63% in the diagnosis of chronic PJI. The combination of D-dimer and CRP tests demonstrated a sensitivity of 98.11% and negative predictive value of 96.55% for the diagnosis of chronic PJI.

Conclusion

The present study identified the D-dimer is a valuable biomarker in detecting chronic PJI. The combinations of serum D-dimer and CRP led to the improvement of sensitivity compared with those of the single-index test.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30743-0/pdf

Entry filed under: Antimicrobianos, Bacterias, BIOFILM - BIOPELICULAS, Biología Molecular, BIOMARCADORES, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Infecciones sitio quirurgico, Metodos diagnosticos, Profilaxis Antibiótica en Cirugía - PAC, REPORTS, Resistencia bacteriana, Sepsis, Update.

Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients. Differences in Diagnostic Properties Between Standard and Enrichment Culture Techniques Used in Periprosthetic Joint Infections


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