ESR and CRP are useful between stages of 2-stage revision for periprosthetic joint infection

Lindsay, Christopher; Olcott, Christopher W.; Gaizo, Daniel J. Del

doi:10.1016/j.artd.2016.08.002

Cited by 17 publications

(19 citation statements)

References 16 publications

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“…However, the plasma D-dimer was inferior to fibrinogen. Nevertheless, compared with the previous studies of serum CRP and ESR reported before reimplantation, plasma D-dimer seems to be a better diagnostic indicator [33,34].…”

Section: Discussioncontrasting

confidence: 67%

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Margaryan

Ojeda-Thies

et al. 2020

Preprint

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Background The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods A systematic search and screen of relevant studies was performed in the PubMed, Web of Science and Embase databases using the following medical subject headings (MeSH) or keywords: “arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint”, “infection or infectious or infected”, and “D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products”. Then, the data were analysed and processed by Meta-Disc software. Results A total of 7 studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 0.75 (95% confidence interval [CI]: 0.70 to 0.79), 0.69 (95% CI: 0.66 to 0.72), 3.01 (95% CI: 1.84 to 4.93), 0.32 (95% CI: 0.19 to 0.53) and 10.20 (95% CI: 3.63 to 28.64), respectively. Subgroup analyses showed that use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI (0.86, 0.84 vs. 0.67, 0.60, respectively). Conclusion Serum D-dimer had a better diagnostic value than plasma D-dimer for the diagnosis of PJI.

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Section: Discussioncontrasting

confidence: 67%

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Margaryan

Ojeda-Thies

et al. 2020

Preprint

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“…In their small case series, Lindsay et al [14] We found that the preexplantation ESR was significantly higher in PJI caused by resistant versus nonresistant bacteria. This is not necessarily surprising given the virulence of MRSA compared with nonresistant bacteria.…”

Section: Discussionmentioning

confidence: 67%

“…We found that both the DESR and DCRP percentages were poor markers of recurrent or persistent infection risk. Several previous studies have investigated how to best monitor infection status using serologic testing in the period before reimplantation [10,13,14,25]. However, all studies of this nature suffer from the fact that two-stage reimplantation is a relatively successful procedure.…”

Section: Discussionmentioning

confidence: 99%

Does Change in ESR and CRP Guide the Timing of Two-stage Arthroplasty Reimplantation?

Stambough

Curtin

Odum

et al. 2018

Clin Orthop Relat Res

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Background Two-stage reimplantation arthroplasty is a commonly used approach for treating chronic periprosthetic joint infections. A prereimplantation threshold value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to determine infection eradication and the proper timing of reimplantation remains ill defined. We theorized that rather than a specific numeric threshold, a percentage of improvement in these serology markers might improve diagnostic accuracy in determining the timing of reimplantation. Question/purposes We investigated if (1) the percent, or delta, change in ESR and CRP values from preresection to prereimplantation (DESR, DCRP) is a useful marker of infection eradication and (2) whether the initial PJI causative organism (resistant, nonresistant, or culture-negative) is associated with serum ESR and CRP values before and after treatment with an antibiotic spacer and parenteral antibiotic therapy. Methods We retrospectively reviewed 300 patients, nine of whom were lost to followup, treated with a two-stage revision THA or TKA protocol between 2005 and 2014 from two separate institutional arthroplasty registries. Serum ESR and CRP values were recorded at two designated points: (1) preresection and (2) after 6 weeks of intravenous antibiotic therapy with a drug-eluting spacer and completion of an organism-specific intravenous antibiotic regimen. Patient records were reviewed electronically for causative species of infection, revision surgeries, and recurrent/persistent infection based on Musculoskeletal Infection Society criteria for a minimum of 2 years. Forty-eight of 291 patients (16%) underwent a revision procedure for recurrent or persistent infection, whereas 31 patients (10%) were revised for noninfectious reasons. The DESR, DCRP, culture results, and patient demographics were recorded and analyzed with receiver operator curves controlling for American Society of Anesthesiologists (ASA) class.

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“…Plasma D-dimer was observed to have a lower sensitivity and specificity than fibrinogen (83.3% and 41.9% vs. 87.5% and 62.8%, respectively); however, it was inferior to fibrinogen. Nevertheless, compared with previous studies on serum CRP and ESR before reimplantation, plasma D-dimer appears to be a better diagnostic indicator [34,35]. The first serum D-dimer study performed by Shahi and co-workers also found that the two cases of failed second stage replacement caused by reinfection had increased D-dimer levels before reimplantation surgery, while serum CRP and ESR levels were normal [13].…”

Section: Discussionmentioning

confidence: 78%

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Margaryan

Ojeda-Thies

et al. 2020

J Orthop Surg Res

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Background: The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods: A systematic search and screening of relevant studies was performed in the databases PubMed, Web of Science, and Embase using the following medical subject headings (MeSH) or keywords: "arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint", "infection or infectious or infected", and "D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products". Data were subsequently analysed and processed using Meta-Disc. Results: Seven studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.75 (95% confidence interval [CI] 0.70-0.79), 0.69 (95% CI 0.66-0.72), 3.01 (95% CI 1.84-4.93), 0.32 (95% CI 0.19-0.53), and 10.20 (95% CI 3.63-28.64), respectively. Subgroup analyses showed that the use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI. Conclusions: Serum D-dimer was shown to have a better diagnostic value than plasma D-dimer for the diagnosis of PJI. Further research is required for clarification.

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ESR and CRP are useful between stages of 2-stage revision for periprosthetic joint infection

Cited by 17 publications

References 16 publications

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

Does Change in ESR and CRP Guide the Timing of Two-stage Arthroplasty Reimplantation?

Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

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