Plasma d -Dimer Levels in Non-prosthetic Orthopaedic Implant Infection: Can it Aid Diagnosis?
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ORIGINAL ARTICLE
Plasma d‑Dimer Levels in Non‑prosthetic Orthopaedic Implant Infection: Can it Aid Diagnosis? Govind Karunakaran1 · Jagdish Menon1 · Sandeep Nema1 · Debadatta Basu2 Received: 11 March 2020 / Accepted: 13 April 2020 / Published online: 24 April 2020 © Indian Orthopaedics Association 2020
Abstract Purpose d-Dimer estimation has been proposed as a reliable biomarker in prosthetic joint infections. Its role in non-prosthetic orthopaedic implant infections has, however, not been studied. The objectives of this study were to assess the levels of plasma d-Dimer in non-prosthetic orthopaedic implant infection. The diagnostic efficiency of d-dimer on orthopaedic implant-related infection was evaluated. Methods The study was designed as a cross-sectional comparative study. Patients who presented with orthopaedic implantrelated infection as diagnosed by modified MSIS criteria were allocated to case group (n = 49) and patients who underwent surgical procedures with orthopaedic implants with no evidence of infection at 6 weeks postoperatively were allocated to the control group (n = 48). Serum d-Dimer levels were assessed quantitatively using immunoturbidimetric assays in both groups and compared between both groups. Results The mean (± SD) value of serum d-Dimer in case group was 0.64 (± 0.45) μg/ml and control group was 0.77 (± 0.47) μg/ml. No significant difference was found in serum d-Dimer levels between cases and control groups (p value = 0.183). The diagnostic accuracy of d-dimer in orthopaedic implant-related infection also could not be demonstrated. Conclusion The findings of d-dimer as a marker for the diagnosis of prosthetic joint infections cannot be extrapolated to non-prosthetic orthopaedic implant infection. Keywords d-dimer · Biomarkers · Implant associated infection · Internal fixation
Introduction Infection, systemic or localised triggers an inflammatory response which results in the release of acute-phase reactants [1]. The measurement of these proteins has been traditionally used as biomarkers of the infective process [1]. Recent research has shown that along with the inflammatory response, the activation of coagulation–fibrinolytic response is an important component in the first line for defence against infection [2]. d-dimer is a degradation product of fibrin and its estimation is routinely used in the evaluation Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43465-020-00120-8) contains supplementary material, which is available to authorized users. * Jagdish Menon [email protected] 1
Department of Orthopaedics, JIPMER, Pondicherry, India
Department of Pathology, JIPMER, Pondicherry, India
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of venous thrombosis [3]. Elevated levels of d-dimer are also encountered in infection due to close interaction of the inflammatory and coagulation pathways [4]. d-dimer levels have been used to diagnosis and prognostication of infection [5–7]. The role of d-dimer in orthopaedic infection has been large
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