The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections

Abstract

Background Fibrinogen (FIB) has been found to be a promising marker in diagnosing periprosthetic joint infection (PJI), however, the value of FIB in predicting reinfection of PJI is unknown. The purpose of this study was to evaluate the value of FIB in predicting reinfection after debridement, antibiotics, and implant retention (DAIR) for PJI. Methods We retrospectively analyzed the clinical data of patients who were diagnosed with PJI and underwent DAIR from 2013 to 2019. The levels of the FIB, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured before DAIR. After DAIR, patients were followed and reinfections were identified. For both acute and chronic PJI, the predictive value of FIB was evaluated by calculating the sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic curve (ROC), and was compared with traditional inflammatory markers including ESR and CRP. Results The expression of FIB differed between patients reinfected and those not reinfected in both acute and chronic PJI (p < 0.05). In patients who underwent DAIR for acute PJI, the sensitivity and specificity of FIB were 81.82 and 83.33%, respectively, which were significantly higher than that of CRP (sensitivity, 72.73%; specificity, 50%; p < 0.05), while the specificity was higher than that of ESR (specificity, 41.67%; p < 0.05). In patients who underwent DAIR for chronic PJI, the sensitivity and specificity of FIB were 80.00 and 66.66%, respectively, which were significantly higher than that of CRP (sensitivity, 53.33%; specificity, 66.66%; p < 0.05) and ESR (sensitivity was 66.00%; specificity, 16.66%; p < 0.05). The ROC curves showed that FIB demonstrated the highest AUC among the biomarkers in both acute and chronic PJI. Conclusion FIB is a promising indicator in predicting reinfection after DAIR for both acute and chronic PJI, and it seems to perform better than ESR and CRP.

The role of antibiotic calcium sulfate beads in acute periprosthetic knee infection: a retrospective cohort study

“…[ 13 ] used DABRI for the first time for the treatment of acute knee PJIs. Two patients failed to respond due to methicillin-resistant Staphylococcus aureus infection, even though the level of C-reactive protein after 30 days of treatment decreased in both cases [ 37 – 39 ].…”

Combination of C-reactive protein and fibrinogen is useful for diagnosing periprosthetic joint infection in patients with inflammatory diseases

“…FIB is also an efficient biomarker for the detection of infection in patients with non-union of fractures after internal fixation, showing a sensitivity of 78.2% and a specificity of 82.4% at an optimal cutoff of 2.75 g/L [28] . In addition, FIB also is promising for predicting reinfection after debridement, antibiotics, and implant retention for both acute and chronic PJI, and it may perform better than CRP and ESR [29] . And it is also promising for screening PJI prior to revision arthroplasty in patients without inflammatory diseases [19,30] .…”

“…[28] In addition, FIB also is promising for predicting reinfection after debridement, antibiotics, and implant retention for both acute and chronic PJI, and it may perform better than CRP and ESR. [29] And it is also promising for screening PJI prior to revision arthroplasty in patients without inflammatory diseases. [19,30] The optimal cutoff values reported in those studies were 3.57 and 4.01 mg/L, respectively, and our study revealed that plasma FIB may be useful at an optimal cutoff of 4.04 mg/L for screening PJI in patients with inflammatory diseases subjected to revision arthroplasty.…”