Comparison of a Comprehensive Set of Fibrinolytic Markers With C-Reactive Protein and Erythrocyte Sedimentation Rate for the Diagnosis of Periprosthetic Joint Infection |
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| Institution: | 1. Department of Joint Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China;2. Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China;1. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY;2. Department of Rheumatology, Hospital for Special Surgery, New York, NY;3. Feinstein Institute, Northwell Health, Manhasset, NY;4. Laboratory of Molecular Neurooncology, Rockefeller University, New York, NY;1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK;2. NIHR Biomedical Research Unit, University of Oxford, Oxford, UK;3. Barts and The London School of Medicine and Dentistry, Oxford, UK;4. Nuffield Orthopaedic Centre, Oxford, UK;1. Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, NY;2. Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria;3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY;4. Department of Anesthesiology, Weill Cornell Medicine, New York, NY;5. Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York City, NY;6. Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY;7. Department of Health Policy and Research, Weill Cornell Medical College, New York, NY |
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| Abstract: | BackgroundThe diagnosis of periprosthetic joint infection (PJI), a serious complication after primary total joint arthroplasty, remains challenging. Recently, fibrinolytic activities have been shown to be closely related to infections and inflammation. However, data assessing the value of fibrinolytic markers for the diagnosis of PJI have been sparse until now.MethodsWe retrospectively enrolled 157 patients undergoing revision for aseptic loosening (n = 106, group A) or revision for chronic PJI (n = 51, group B) from January 2014 to August 2019. PJI was defined using the Musculoskeletal Infection Society criteria. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, fibrin degradation product (FDP), and fibrinogen were measured preoperatively. The diagnostic values of each biomarker were analyzed and compared using receiver operating characteristic curves, sensitivity, and specificity.ResultsCompared with group A, group B had significantly higher levels of CRP, ESR, D-dimer, FDP, and fibrinogen (P < .001). The area under the curve of fibrinogen was 0.914, which was slightly lower than that of CRP (0.924). FDP and D-dimer had area under the curve values of 0.808 and 0.784, respectively. The optimal threshold, sensitivity, and specificity were 3.56 g/L, 86.27%, and 83.96% for fibrinogen; 1.22 mg/L, 66.67%, and 85.85% for D-dimer; and 3.98 μg/mL, 72.55%, and 80.19% for FDP, respectively.ConclusionFibrinolytic markers provided promising diagnostic support for PJI, especially fibrinogen, which had a diagnostic efficiency similar to that of CRP and ESR. |
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| Keywords: | periprosthetic joint infection fibrinogen D-dimer fibrin degradation product diagnosis |
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