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Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection |
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| Institution: | 1. Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China;2. Department of Orthopedics, The Dazu District People’s Hospital, Chongqing, China;3. Outpatient Department, Chongqing General Hospital, Chongqing, China;1. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Medical College, Soochow University, Suzhou, Jiangsu, China;1. Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany;2. Federal Center of Traumatology, Orthopedics and Arthroplasty, Barnaul, Russia;3. Berlin-Brandenburg School for Regenerative Therapies (BSRT), Charité – Universitätsmedizin Berlin, Berlin, Germany;1. Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;2. Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;3. Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands |
| Abstract: | BackgroundDiagnosis 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.MethodsOne 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.ResultsThe 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.ConclusionThe 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. |
| Keywords: | periprosthetic joint infection diagnostic test D-dimer C-reactive protein erythrocyte sedimentation rate |
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