The Utility of Serum D-Dimer for the Diagnosis of Periprosthetic Joint Infection in Revision Total Hip and Knee Arthroplasty
The Utility of Serum D-Dimer for the Diagnosis of Periprosthetic Joint Infection in Revision Total Hip and Knee Arthroplasty
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DOI：
10.1016/j.arth.2020.01.034
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发表时间：
2020-06-01
影响因子：
3.5
通讯作者：
Higuera, Carlos A.
中科院分区：
文献类型：
--
作者：
Pannu, Tejbir S.;Villa, Jesus M.;Higuera, Carlos A.
背景资料：在全髋关节（THA）和膝关节（TKA）翻修术中，使用血清D-二聚体诊断假体周围关节感染的证据很少且存在矛盾。因此，本研究的目的是测试血清D-二聚体对2013年国际共识会议（ICM）criteria.Methods的准确性：一项回顾性研究进行了一系列的172个修订THA/TICS手术进行了3个研究员培训的外科医生在一个单一的机构（2017年8月至2019年5月），并在他们的术前检查D-二聚体。在该队列中，111例（42例THA/69例TKA）病例完成了2013 ICM标准测试，并被纳入最终分析。根据2013 ICM标准（“金标准”）对脓毒症和无菌性翻修进行分类，并使用既定阈值（850 ng/mL）与血清D-二聚体进行比较。确定灵敏度、特异性、似然比和阳性/阴性预测值。独立的t检验，Fisher精确检验，卡方检验，和接收器操作特征曲线analysed.Results：有没有统计学意义上的基线人口统计学之间的败血症和无菌病例每2013年ICM标准的差异。与ICM标准相比，D-二聚体诊断假体周围关节感染的敏感性（95.9%）和阴性预测值（90.9%）较高，但特异性（32.3%）和阳性预测值（52.8%）较低，总体准确性较差（61%）。阳性似然比为1.42，阴性似然比为0.13。曲线下面积（AUC）为0.742。结论：在翻修THA和TKA的情况下，使用所描述的阈值区分感染性和无菌性病例的准确性较差。(C)2020爱思唯尔公司All rights reserved.
Background: There is scarce and contradicting evidence supporting the use of serum D-dimer for the diagnosis of periprosthetic joint infection in revision total hip (THA) and knee (TKA) arthroplasty. Therefore, the purpose of this study is to test the accuracy of serum D-dimer against the 2013 International Consensus Meeting (ICM) criteria.Methods: A retrospective review was performed on a consecutive series of 172 revision THA/TICS surgeries performed by 3 fellowship-trained surgeons at a single institution (August 2017 to May 2019) and that had D-dimer performed during their preoperative workup. Of this cohort, 111 (42 THAs/69 TKAs) cases had complete 2013 ICM criteria tests and were included in the final analysis. Septic and aseptic revisions were categorized per 2013 ICM criteria ("gold standard") and compared against serum D-dimer using an established threshold (850 ng/mL). Sensitivity, specificity, likelihood ratios, and positive/negative predictive values were determined. Independent t-tests, Fisher's exact tests, chi-squared tests, and receiver operating characteristic curve analysis were performed.Results: There was no statistically significant difference in baseline demographics between septic and aseptic cases per 2013 ICM criteria. When compared to ICM criteria, D-dimer demonstrated high sensitivity (95.9%) and negative predictive value (90.9%) but low specificity (32.3%), positive predictive value (52.8%), and overall, poor accuracy (61%) to diagnose periprosthetic joint infection. Positive likelihood ratio was 1.42 while negative likelihood ratio was 0.13. The area under the curve (AUC) was 0.742.Conclusion: Serum D-dimer has poor accuracy to discriminate between septic and aseptic cases using a described threshold in the setting of revision THA and TKA. (C) 2020 Elsevier Inc. All rights reserved.