Plasma Fibrinogen and Platelet Count Are Referable Tools for Diagnosing Periprosthetic Joint Infection: A Single-Center Retrospective Cohort Study |
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| Institution: | 1. Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People''s Republic of China;2. Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, People''s Republic of China;3. Department of Orthopedics, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, People''s Republic of China;4. Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People''s Republic of China;1. Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH;2. All-Indian Institute of Medical Sciences, Ansari Nagar, New Delhi, India;1. Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium;2. Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, UCL, Brussels, Belgium;3. Department of Orthopedic Surgery, Genk, Belgium;4. Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg, Belgium |
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| Abstract: | BackgroundAlthough the MusculoSkeletal Infection Society has suggested a series of markers to diagnose periprosthetic joint infection (PJI), no single marker can accurately identify infection before revision hip or knee arthroplasty, and exploring promising markers to easily and reliably diagnose PJI is ongoing. The aim of this study was to evaluate the diagnostic value of plasma fibrinogen and platelet count for diagnosing PJI.MethodsWe retrospectively included 439 patients who underwent revision arthroplasty from January 2008 to December 2018; 79 patients with coagulation-related comorbidities were evaluated separately. The remaining 360 patients constituted 153 PJI and 207 non-PJI patients. Receiver operating characteristic curves were used to evaluate the maximum sensitivity and specificity of the tested markers.ResultsThe receiver operating characteristic curves showed that the areas under the curve for plasma fibrinogen, platelet count, and serum C-reactive protein and erythrocyte sedimentation rate were 0.834, 0.746, 0.887, and 0.842, respectively. Based on Youden's index, the optimal predictive cutoffs for fibrinogen and platelet count were 3.57 g/L and 221 × 109/L, respectively. The sensitivity and specificity, respectively, were 68.6% and 86.0% (fibrinogen) and 57.5% and 83.1% (platelet count) for diagnosing PJI. The sensitivity and specificity, respectively, were 76.7% and 72.2% (fibrinogen) and 48.8% and 63.9% (platelet count) for diagnosing PJI in patients with coagulation-related comorbidities.ConclusionPlasma fibrinogen performed well for diagnosing PJI before revision arthroplasty, and its value neared that of traditional inflammatory markers. Although the diagnostic value of the platelet count was inferior to traditional markers, its diagnostic value was fair for diagnosing PJI. Fibrinogen also may be useful for diagnosing PJI in patients with coagulation-related comorbidities. |
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| Keywords: | joint arthroplasty periprosthetic joint infection fibrinogen platelet diagnosis |
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