The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
- PMID: 34013679
- DOI: 10.1515/dx-2021-0032
The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
Abstract
Objectives: The current literature on diagnosis of periprosthetic joint infection (PJI) provides controversial evidence on the diagnostic accuracy of D-dimer. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of D-dimer for diagnosing PJI.
Content: We searched MEDLINE, Scopus, and Web of Science, for studies on D-dimer for diagnosing PJI, according to the PRISMA flowchart. QUADAS was used for assessing study quality. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed using bivariate diagnostic random-effects model. The area under the receiver-operating curve (AUC-ROC) was calculated. Subgroup analysis and univariate meta-regression were carried out for detecting potential sources of heterogeneity.
Summary: We included 12 articles, totaling 1,818 patients (539 with PJI). The pooled sensitivity and specificity of D-dimer for diagnosing PJI were 0.739 (95% CI: 0.616-0.833) and 0.785 (95% CI: 0.679-0.863). The pooled PLR, NLR, DOR were 3.359 (95% CI, 2.340-4.821), 0.295 (95% CI, 0.180-0.484), and 11.787 (95% CI, 5.785-24.018). The cumulative ROC plot displayed an AUC of 0.688 (95% CI, 0.663-0.713; p<0.001). No threshold effects could be observed. The type of blood sample was identified as possible source of heterogeneity for DOR (p=0.01).
Outlook: Evidence emerged from this meta-analysis suggests that D-dimer displays sufficient diagnostic accuracy to rule out PJI. The type of blood sample (plasma vs. serum) and the study design could influence the results in terms of DOR and sensitivity. However, further perspective studies would be needed to validate its potential diagnostic usefulness.
Keywords: D-dimer; arthroplasty; diagnosis; periprosthetic joint infection.
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
Similar articles
-
The accuracy of D-dimer in the diagnosis of periprosthetic infections: a systematic review and meta-analysis.J Orthop Surg Res. 2022 Feb 16;17(1):99. doi: 10.1186/s13018-022-03001-y. J Orthop Surg Res. 2022. PMID: 35172830 Free PMC article. Review.
-
Diagnostic accuracy of synovial fluid D-lactate for periprosthetic joint infection: a systematic review and meta-analysis.J Orthop Surg Res. 2021 Oct 16;16(1):606. doi: 10.1186/s13018-021-02778-8. J Orthop Surg Res. 2021. PMID: 34656157 Free PMC article. Review.
-
Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials.J Orthop Surg Res. 2021 Jan 9;16(1):30. doi: 10.1186/s13018-020-02109-3. J Orthop Surg Res. 2021. PMID: 33422082 Free PMC article.
-
Diagnostic accuracy of D-dimer in periprosthetic joint infection: a diagnostic meta-analysis.J Orthop Surg Res. 2020 Aug 17;15(1):334. doi: 10.1186/s13018-020-01853-w. J Orthop Surg Res. 2020. PMID: 32807236 Free PMC article.
-
D-dimer in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.J Orthop Surg Res. 2020 Jul 16;15(1):265. doi: 10.1186/s13018-020-01761-z. J Orthop Surg Res. 2020. PMID: 32677991 Free PMC article.
Cited by
-
Unreliability of Serum- or Plasma-based Assays of D-dimer or Fibrin (Fibrinogen) Degradation Product for Diagnosing Periprosthetic Joint Infection: A Prospective Parallel Study.Orthop Surg. 2024 Jan;16(1):29-37. doi: 10.1111/os.13935. Epub 2023 Nov 17. Orthop Surg. 2024. PMID: 37975182 Free PMC article.
-
How we manage a high D-dimer.Haematologica. 2024 Apr 1;109(4):1035-1045. doi: 10.3324/haematol.2023.283966. Haematologica. 2024. PMID: 37881856 Free PMC article. Review.
-
Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023.Antibiotics (Basel). 2023 Jun 15;12(6):1054. doi: 10.3390/antibiotics12061054. Antibiotics (Basel). 2023. PMID: 37370373 Free PMC article. Review.
-
Utility of D-dimer in total joint arthroplasty.World J Orthop. 2023 Mar 18;14(3):90-102. doi: 10.5312/wjo.v14.i3.90. eCollection 2023 Mar 18. World J Orthop. 2023. PMID: 36998388 Free PMC article. Review.
-
Diagnostic Performance of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Platelet to Mean Platelet Volume Ratio in Periprosthetic Hip and Knee Infections: A Systematic Review and Meta-Analysis.Diagnostics (Basel). 2022 Aug 23;12(9):2033. doi: 10.3390/diagnostics12092033. Diagnostics (Basel). 2022. PMID: 36140435 Free PMC article. Review.
References
-
- Kurtz, SM, Ong, KL, Lau, E, Bozic, KJ, Berry, D, Parvizi, J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010;468:52–6. https://doi.org/10.1007/s11999-009-1013-5.
-
- Balato, G, Ascione, T, De Franco, C, De Matteo, V, Verrazzo, R, Smeraglia, F, et al.. Blood loss and transfusion rate in patients undergoing two-stage exchange in infected total knee arthroplasty. J Biol Regul Homeost Agents 2020;34:1–5.
-
- Gehrke, T, Alijanipour, P, Parvizi, J. The management of an infected total knee arthroplasty. Bone Joint J 2015;97-B:20–9. https://doi.org/10.1302/0301-620X.97B10.36475.
-
- Balato, G, Ascione, T, Rosa, D, Pagliano, P, Solarino, G, Moretti, B, et al.. Release of gentamicin from cement spacers in two-stage procedures for hip and knee prosthetic infection: an in vivo pharmacokinetic study with clinical follow-up. J Biol Regul Homeost Agents 2015;29:63–72.
-
- Ascione, T, Balato, G, Mariconda, M, Rotondo, R, Baldini, A, Pagliano, P. Continuous antibiotic therapy can reduce recurrence of prosthetic joint infection in patients undergoing 2-stage exchange. J Arthroplasty 2019;34:704–9. https://doi.org/10.1016/j.arth.2018.12.017.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources