Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection A Multicenter Retrospective Study
Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection A Multicenter Retrospective Study
复制标题
血浆纤维蛋白原在诊断假体周围感染方面比血浆 D-二聚体表现出更好的性能 一项多中心回顾性研究
DOI：
10.2106/jbjs.18.00624
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发表时间：
2019-04-03
影响因子：
5.3
通讯作者：
Chen, Ji-Ying
中科院分区：
文献类型：
--
作者：
Li, Rui;Shao, Hong-Yi;Chen, Ji-Ying
背景：寻找及时准确诊断人工关节感染（PJI）的潜在标志物仍在进行中。以前的研究主要集中在炎症标志物，很少检查凝血相关指标。本研究的目的是通过多中心回顾性研究评估血浆纤维蛋白原、D-二聚体和其他血液标志物对PJI诊断的价值。方法：本研究共纳入2016年1月至2017年12月期间565例翻修全髋关节和膝关节置换术病例，其中126例存在凝血相关合并症，并进行单独分析。其余439例病例包括76例PJI和363例非PJI患者。PJI的定义基于假体周围感染标准国际共识会议（ICM）。采用受试者工作特征曲线（ROC）分析D-二聚体、纤维蛋白原、血沉（ESR）、C反应蛋白（CRP）、白色细胞（WBC）等指标的诊断价值。ROC曲线显示，血浆纤维蛋白原的曲线下面积（AUC）最高，为0.852，其次是CRP和ESR，其AUC分别为0.810和0.808。D-二聚体的AUC为0.657，这是第二低值，仅略高于WBC计数的AUC 0.590。血浆D-二聚体的最佳阈值为1.25 μ g/mL，灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为0.645、0.650、0.278和0.897。血浆纤维蛋白原的最佳阈值为4.01 g/L，表现出良好的敏感性，特异性，PPV和NPV，值分别为0.763，0.862，0.537，和0.946.Conclusions：血浆D-二聚体可能有一个非常有限的诊断价值PJI，而血浆纤维蛋白原，另一个凝血相关指标，表现出良好的性能。血浆纤维蛋白原诊断PJI具有良好的敏感性和特异性，其值与经典标志物CRP水平和ESR相似。
Background: The search for potential markers for a timely and accurate diagnosis of peri prosthetic joint infection (PJI) is ongoing. Previous studies have focused on inflammatory markers and have rarely examined coagulation-related indicators. The purpose of this study was to evaluate the values of plasma fibrinogen, D-dimer, and other blood markers for the diagnosis of PJI through a multicenter retrospective study.Methods: A total of 565 revision total hip and knee arthroplasty cases were enrolled in this study from January 2016 through December 2017, 126 of which had coagulation-related comorbidities and were analyzed separately. The remaining 439 cases included 76 PJI and 363 non-PJI patients. The definition of PJI was based on the International Consensus Meeting (ICM) on Periprosthetic Infection criteria. The diagnostic values of D-dimer, plasma fibrinogen, the erythrocyte sedimentation rate (ESR), C reactive protein (CRP) level, and white blood-cell (WBC) count were analyzed using receiver operating characteristic (ROC) curves.Results: ROC curves showed that plasma fibrinogen had the highest area under the curve (AUC), 0.852, followed by 2 classical markers, the CRP level and ESR, which had an AUC of 0.810 and 0.808, respectively. D-dimer had an AUC of 0.657, which was the second lowest value and only slightly higher than that of the WBC count, 0.590. The optimal threshold for plasma D-dimer was 1.25 mu g/mL, with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.645, 0.650, 0.278, and 0.897, respectively. The optimal threshold for plasma fibrinogen was 4.01 g/L, which showed good sensitivity, specificity, PPV, and NPV, with values of 0.763, 0.862, 0.537, and 0.946, respectively.Conclusions: Plasma D-dimer may have a very limited diagnostic value for PJI, while plasma fibrinogen, another coagulation-related indicator, exhibits promising performance. Plasma fibrinogen has good sensitivity and specificity for diagnosing PJI, with values similar to those of classical markers, including CRP level and ESR.