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.

Utility of D-dimer in total joint arthroplasty

“…Serum D-dimer demonstrated excellent diagnostic value with an AUC of 0.91, far above that of plasma D-dimer (AUC of 0.66). Other authors have further supported this finding[ 80 , 82 - 87 ]. Some studies have reported no difference in baseline D-dimer levels when using either of the two techniques, however, Boisclair et al [ 89 ] reported significant differences in sensitivity and specificity when examining serum vs plasma D-dimer in the diagnosis of disseminated intravascular coagulation, DVT, and myocardial infarction[ 88 , 89 ].…”

“…A collection of systematic reviews and meta-analyses were recently published in an effort to eliminate confusion and draw clarity from the literature[ 80 - 87 ]. The overall pooled data displays that D-dimer has good diagnostic accuracy to detect PJI.…”

“Unexpected” Infections in Revision Arthroplasty for Aseptic Loosening

“…Причины, способствующие увеличению значений D-димера у пациентов с асептической нестабильностью: тромботические расстройства, воспалительные заболевания, послеоперационные состояния, онкозаболевания, инфекции, травмы,кровоизлияния и даже коронавирусная болезнь (COVID-19). D-димер в основном является маркером системного фибринолиза и оборота фибрина, так что на его значения потенциально могут влиять многие факторы: возраст, пол, индекс массы тела, сопутствующие сердечно-сосудистые заболевания, требующие лечения антикоагулянтами [34]. Высокая доля отклонений значений D-димера от нормы в нашем исследовании (41,8%) может быть объяснена отсутствием информации о сопутствующих заболеваниях пациентов, которые могли оказать значительное влияние на значения D-димера.…”

The combined evaluation of fibrinogen and D‐dimer levels are a helpful tool to exclude periprosthetic knee infection

“…Furthermore, serum d ‐dimer measurement was recently proposed as part of the PJI diagnostic workup due to its potential diagnostic accuracy. Recently, three meta‐analyses reported discordant results in evaluating the accuracy of serum d ‐dimer in diagnosing PJI 18–20 . We, therefore, asked: (1) What are the most appropriate thresholds for d ‐dimer and fibrinogen in patients with painful total knee arthroplasty?…”