Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection.
Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection.
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DOI：
10.3390/jcm9092917
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发表时间：
2020-09-10
影响因子：
3.9
通讯作者：
Theil C
中科院分区：
文献类型：
--
作者：
Ackmann T;Möllenbeck B;Gosheger G;Schwarze J;Schmidt-Braekling T;Schneider KN;Frommer A;Dieckmann R;Theil C
简介：D-二聚体是肌肉骨骼感染学会（MSIS）2018年制定的假体周围关节感染（PJI）的诊断标准。本研究的目的是评估血清D-二聚体值与C-反应蛋白（CRP）和白细胞介素-6（IL-6）的比较，以诊断PJI。材料与方法：我们纳入了119例接受翻修关节置换术的患者（50例女性，69例男性; 71例膝关节，48例髋关节），术前评估CRP、IL-6和血清D-二聚体。根据2018年MSIS标准，病例被分类为感染或无菌。受试者工作曲线和约登指数用于定义理想的截止值以及各个参数的灵敏度和特异性，并使用交叉表计算相应的组合。结果如下：与无菌性失败组相比，PJI组的D-二聚体水平中位数（2320 vs. 1105 ng/mL; p <0.001）、CRP水平中位数（4.0 vs. 0.5 mg/dL; p < 0.001）和IL-6水平中位数（21.0 vs. 5.0 pg/mL; p < 0.001）显著较高。D-二聚体、CRP和IL-6的计算最佳临界值分别为2750 ng/mL（AUC 0.767）、1.2 mg/dL（AUC 0.914）和10.0 pg/mL（AUC 0.849）。D-二聚体的敏感性为38%，特异性为94%，而CRP和IL-6的敏感性分别为88%和76%，特异性分别为87%和92%。结论：与CRP和IL-6相比，血清D-二聚体在本队列中的敏感性和特异性较低。CRP与IL-6联合检测敏感性最高，IL-6与D-二聚体或CRP与IL-6联合检测特异性最高。
Introduction: D-dimer is a diagnostic criterion for periprosthetic joint infection (PJI) of the Musculoskeletal Infection Society (MSIS) in 2018. The aim of this study was to evaluate the serum D-dimer values in comparison to C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of PJI. Materials and Methods: We included 119 patients (50 women, 69 men; 71 knees, 48 hips) undergoing revision arthroplasty with preoperative assessment of CRP, IL-6, and serum D-dimer. Cases were classified as infected or aseptic based on the MSIS criteria of 2018. Receiver operating curves and Youden’s index were used to define an ideal cut-off value and sensitivity and specificity for the individual parameters, and respective combinations were calculated using cross-tables. Results: The median D-dimer level (2320 vs. 1105 ng/mL; p < 0.001), the median CRP level (4.0 vs. 0.5 mg/dL; p < 0.001), and the median IL-6 level (21.0 vs. 5.0 pg/mL; p < 0.001) were significantly higher in the group of PJI compared to the group with aseptic failure. The calculated optimal cut-off values were 2750 ng/mL (AUC 0.767) for D-dimer, 1.2 mg/dL (AUC 0.914) for CRP, and 10.0 pg/mL (AUC 0.849) for IL-6. D-dimer showed a sensitivity of 38% and specificity of 94%, whereas the CRP and IL-6 had sensitivities of 88% and 76%, and specificities of 87% and 92%, respectively. Conclusion: In comparison with CRP and IL-6, serum D-dimer showed low sensitivity and specificity in our cohort. While CRP and IL-6 combination had the highest sensitivity, a combination of Il-6 and D-dimer or CRP and IL-6 had the highest specificity.
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影响因子：
2.3
作者：
Franklin PD;Miozzari H;Christofilopoulos P;Hoffmeyer P;Ayers DC;Lübbeke A
通讯作者：
Lübbeke A
影响因子：
3.5
作者：
Pannu, Tejbir S.;Villa, Jesus M.;Higuera, Carlos A.
通讯作者：
Higuera, Carlos A.
影响因子：
4.6
作者：
Fink, B.;Schuster, P.;Schlumherger, M.
通讯作者：
Schlumherger, M.
影响因子：
3.5
作者：
Shohat, Noam;Bauer, Thomas;Zimmerli, Werner
通讯作者：
Zimmerli, Werner
影响因子：
3.1
作者：
Parvizi J;Cavanaugh PK;Diaz-Ledezma C
通讯作者：
Diaz-Ledezma C