Plasma D-Dimer Can Diagnose Periprosthetic Joint Infection

Feb 28, 2023

TUESDAY, Feb. 28, 2023 (HealthDay News) — Plasma D-dimer is noninferior to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for diagnosing periprosthetic joint infection (PJI) among patients undergoing revision hip or knee arthroplasty, according to a study published online Feb. 9 in the Journal of Bone & Joint Surgery.

Saad Tarabichi, M.D., from the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, and colleagues conducted a prospective study involving 502 patients undergoing revision hip or knee arthroplasty to examine the diagnostic utility of plasma D-dimer for PJI. Plasma D-dimer, ESR, CRP, and fibrinogen were measured preoperatively, and their utility in the diagnosis of PJI was assessed.

The researchers found that 317 of 412 patients included (76.9 percent) did not have an infection, while 95 (23.1 percent) had PJI. The four biomarkers had comparable accuracy for the diagnosis of PJI. Area under the curve, sensitivity, and specificity, respectively, were: 0.860, 81.3 percent, and 81.7 percent for D-dimer; 0.862, 90.4 percent, and 70.0 percent for CPR; 0.833, 73.9 percent, and 85.2 percent for ESR; and 0.798, 74.7 percent, and 75.4 percent for fibrinogen. D-dimer demonstrated the highest sensitivity at 93.8 percent for diagnosing infection caused by indolent organisms.

“We found that plasma D-dimer was noninferior to serum CRP and ESR and may be a useful adjunct when screening patients undergoing revision [total joint arthroplasty],” the authors write. “However, due to heterogeneity in the measurement of D-dimer levels, the application of a universal diagnostic threshold is not currently recommended.”

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