Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection
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(2019) 14:240
RESEARCH ARTICLE
Open Access
Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection Longjiang Xiong1,2, Siyun Li2 and Min Dai3*
Abstract Background: Despite the availability of several biomarkers, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities and has been reported as an inflammatory biomarker. However, quite a few articles have reported the diagnostic efficiency of D-dimer for PJI. Methods: This prospective study enrolled patients who had undergone total joint arthroplasty, were suspected of PJI, and also prepared for revision arthroplasty. PJI was defined using the Musculoskeletal Infection Society criteria. In all patients, serum D-dimer level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were measured preoperatively. We then compared the diagnostic efficiency of these three biomarkers. Results: The median D-dimer level was significantly higher (p < 0.001) for the patients with PJI than for the patients with aseptic failure. With a sensitivity of 80.77% (95% CI, 65.62 to 95.92%) and a specificity of 79.63% (95% CI, 68.89 to 90.37%), the diagnostic efficiency of D-dimer did not outperform serum CRP (with a sensitivity of 84.61% and specificity of 64.81%) and ESR (with a sensitivity of 73.08% and specificity of 90.47%). Conclusions: Serum D-dimer as a marker for the diagnosis of PJI still requires more large-scale and detailed clinical trials. Keywords: Periprosthetic joint infection, Biomarkers, D-dimer, Erythrocyte sedimentation rate, C-reactive protein
Background Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) is one of the most dreadful complications and it has extremely negative effects on the physical, emotional, social, and economic aspects of a patient’s life [1, 2]. Currently, an absolute test for the diagnosis of PJI does not exist, compelling clinicians to rely on a combination of synovial fluid tests and serological markers [3]. Due to the lack of an absolute test, the Musculoskeletal Infection Society (MSIS) introduced a set of diagnostic criteria for PJI. The MSIS guidelines include two major and six minor diagnostic criteria, with the latter involving measurements of serum C-reactive protein (CRP) level, * Correspondence: [email protected] 3 Department of Orthopedics, The First Affiliated Hospital of Nanchang University, NO.17, Yongwai Street, Nanchang 330006, China Full list of author information is available at the end of the article
erythrocyte sedimentation rate (ESR), synovial fluid white blood cell (WBC) count, and neutrophil differential, culture, and leukocyte esterase testing. Although numerous serological markers for PJI have been evaluated in the past, including interleukin 6 (IL-6), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have been generally used as a screening test for infection because of their simpli
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