D-dimer for diagnosis of periprosthetic joint infection: A meta-analysis |
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| Institution: | 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. Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan;2. Department of Clinical Biomechanics, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan;1. Department of Orthopaedics, Shinshu University School of Medicine, Japan;2. First Department of Orthopaedics, Dokkyo Medical University Saitama Medical Center, Japan;1. Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan;2. Department of Orthopaedic Surgery, Saiseika Hospital, Wakayama, Japan;3. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan;1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan;2. Japanese Organization for the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;3. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan;4. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;5. Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, 455-8530, Aichi, Japan;6. Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata-shi, 951-8510, Niigata, Japan;7. Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan;8. Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, 649-7113, Wakayama, Japan;9. Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Wakayama, Japan;10. Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, 329-0498, Tochigi, Japan;11. Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita Ward, Okayama, 701-1192, Okayama, Japan;12. Department of Orthopaedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuocho, 892-8502, Kagoshima, Japan;13. Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, 663-8501, Hyogo, Japan;14. Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5 Chome-11-5 Nishikawaguchi, Kawaguchi, 332-8558, Saitama, Japan;15. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1 Handayama, Higashi Ward, Hamamatsu, 432-8580, Shizuoka, Japan;p. Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898, Yamanashi, Japan;q. Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho Hirosaki, 036-8562, Aomori, Japan;r. Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan;s. Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan;t. Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, 160-8402, Tokyo, Japan;u. Department of Orthopaedic Surgery, Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, 152-8902, Tokyo, Japan;1. Spine and Spinal Cord Center, International University of Health and Welfare (IUHW), Mita Hospital, Tokyo, Japan;2. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan;3. Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan;4. Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan;5. Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan;6. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan;7. Keio Spine Research Group (KSRG), Tokyo, Japan |
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| Abstract: | BackgroundThe D-dimer test is easily available to detect periprosthetic joint infection (PJI). This study aimed to estimate the diagnostic accuracy of the D-dimer test in PJI diagnosis and identify possible independent factors affecting the diagnostic value of this test.MethodsMEDLINE and EMBASE databases identified literature until February 2020 that utilized the D-dimer test for PJI diagnosis. The pooled sensitivity, specificity, area under the curve (AUC), diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated to evaluate the diagnostic accuracy of the D-dimer test. Meta-regression and subgroup analyses were performed to assess potential heterogeneity.ResultsThe databases identified 243 records, and eight studies were included in the final analysis. The pooled sensitivity and specificity of the D-dimer test for PJI diagnosis were 0.78 (95% confidence interval CI], 0.69–0.84) and 0.74 (95% CI, 0.85–0.99), respectively. The AUCs and DORs of the D-dimer test were 0.83 (95% CI, 0.79–0.86) and 10 (95% CI, 4–24), respectively. The PLR and NLR of the D-dimer test for PJI detection were 3.0 (95% CI, 1.9–4.8) and 0.30 (95% CI, 0.20–0.47), respectively. The results of the meta-regression and subgroup analyses indicated that studies that excluded patients with hypercoagulation disorder had higher sensitivity (0.85 vs 0.86) and specificity (0.83 vs 0.62). The sensitivity of the D-dimer test also improved in studies that excluded patients with inflammatory arthritis (0.81 vs 0.75).ConclusionThe D-dimer test is a practical method for PJI diagnosis, especially in patients without history of hypercoagulation disorder and inflammatory arthritis. |
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