Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection

Li, Rui; Shao, Hongyi; Hao, Libo; Yu, Baozhan; Qu, Peng-Fei; Zhou, Yixin; Chen, Jiying

doi:10.2106/jbjs.18.00624

Cited by 133 publications

(205 citation statements)

References 25 publications

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“…In comparison, D-dimer had much lower values of 64.5% sensitivity and 65.0% specificity [49]. D-dimer, when combined with other biomarker tests, is seen to have an increase in specificity, because D-dimer on its own had sensitivity and specificity values of 67.44% and 44.09%.…”

Section: Biomarkersmentioning

confidence: 90%

“…Fibrinogen has been found to be a more promising marker with sensitivity and specificity similar to that of traditional inflammatory markers. Plasma fibrinogen sensitivity and specificity range from 76.3-81.0% and 25.0-86.2%, respectively [49,50]. Plasma fibrinogen has even been shown to have sensitivity as high as 90% when the threshold was lowered to 519 mg/dL, but the specificity of the test still suffered, reaching only 34% [50].…”

Section: Biomarkersmentioning

confidence: 99%

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Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

Berns

Barrett

Gardezi

et al. 2020

Surgical Infections

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Background: Currently, one of the most pressing problems in the field of orthopedic surgery is peri-prosthetic joint infection [PJI]. While there are numerous ways to detect PJI, current clinical detection methods differ across institutions and have varying criteria and protocols. Some of these methods include the Modified Musculoskeletal Infection Society system, culturing, polymerase chain reaction, the determination of the presence of certain biomarkers, testing for the presence of alpha defensin peptides, and leukocyte level testing. Methods: This review summarizes the most recent publications in the field of PJI detection to highlight current strengths as well as provide future directions to find the system for the quickest, cost-effective, and most accurate way to diagnose these types of infections. Results: The results of this literature review suggest that, while each method of diagnosis has its advantages, each has various drawbacks as well. Current methods can be expensive, take days to weeks to complete, be prone to contamination, and can produce ambiguous results. Conclusions: The findings in this review emphasize the need for a more comprehensive and accurate system for diagnosing PJI. In addition, the specific comparison of advantages and drawbacks can be useful for researchers and clinicians with goals of creating new diagnostic tests for PJIs, as well as in clinical scenarios to determine the correct treatment for patients.

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Section: Biomarkersmentioning

confidence: 90%

Section: Biomarkersmentioning

confidence: 99%

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

Berns

Barrett

Gardezi

et al. 2020

Surgical Infections

View full text Add to dashboard Cite

show abstract

“…Besides, the value of fibrinogen and ESR had the tendency to be significance. This is no surprisingly given that the utility and threshold of the four serum markers had been thoroughly studied [16,22,27,28]. However, at the time of reimplantation, values of CRP and fibrinogen were significant higher in re-infection.…”

Section: Discussionmentioning

confidence: 99%

“…Interleukin-6 (IL-6) was proved to be useful in diagnose PJI [12][13][14], and Hoell et al reported the good utility of IL-6 in predicting failure of reimplantation [15]. Li et al reported fibrinogen had good performance in diagnosis of PJI [16]. However, more research is needed to determine the accuracy and reliability of these serum indicators in predicting the proper timing of reimplantation.…”

Section: Introductionmentioning

confidence: 99%

Change in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange ArthroplastyChange in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Jiang¹,

Yang²,

Xu³

et al. 2020

Preprint

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BackgroundTwo-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in first stage, the proper timing of reimplantation is crucial for successful treatment. So far, there is no gold reference to determine the eradication of PJI before reimplantation. The combination of serum indicators, synovial white cell count (WBC), culture results, intraoperative histology, and clinical symptoms is used extensively to guide the timing of reimplantation. However, the proper timing of reimplantation was ill defined.PurposeWe wonder: (1) the utility of serum indicators, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, when predicted failure of reimplantation; (2) correlation between primary culture results and serum markers’ change.MethodA retrospective review of 226 patients treated with a two-stage exchange arthroplasty from 2014 to 2017 was conducted. PJI was diagnosed by using the Musculoskeletal Infection Society (MSIS) criteria. Serum biomarkers and organisms results at the set of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 year; receiver operator characteristic (ROC) depicted the utility of change in four serum markers when predicted failure.ResultsThe ROC area under the curves (AUC) was 0.543 in CRP, 0.572 in IL-6, 0.621 in ESR, 0.463 in fibrinogen and the combination of them was 0.709 when predicted persistent PJI using value change. The AUC of ROC was 0.521 in CRP, 0.472 in IL-6, 0.413 in ESR, 0.552 in fibrinogen and the combination was 0.630 when determine reimplantation by percent change. No significant association was found between culture results and change in serum markers.ConclusionNeither percent change nor value change in serum makers was proved to be poor markers when predicted persistent PJI, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still tough to diagnose. The combination of clinical symptom, pathology results, synovial fluid analysis and serum markers may improve the utility.

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“…Interleukin-6 (IL-6) was suggested to be useful in diagnosing PJI [12][13][14], and Hoell et al reported the high utility of IL-6 in predicting reimplantation failure [15]. Li et al reported that fibrinogen had good performance in the diagnosis of PJI [16]. However, more research is needed to determine the accuracy and reliability of these serum indicators for predicting the proper timing of reimplantation.…”

Section: Introductionmentioning

confidence: 99%

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Jiang

Yang

et al. 2020

Preprint

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Background Two-stage exchange arthroplasty is a viable choice for prosthetic joint infection (PJI). After removing the infected prosthesis and implanting an antibiotic-loaded spacer in the first stage, the proper timing of reimplantation is crucial for successful treatment. To date, there is no gold standard to evaluate the eradication of PJI before reimplantation. A combination of serum indicators, synovial blood white cell (WBC) counts, culture results, intraoperative histology, and clinical symptoms is wildly used to guide the timing of reimplantation. However, the proper timing of reimplantation is not clearly defined. We investigated whether: (1) serum indicators, which included the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, were useful indicators for predicting the failure of reimplantation; and (2) primary culture results were related to serum marker changes? Method A retrospective review of 109 patients treated with two-stage exchange arthroplasty from 2014 to 2017 was conducted. The inclusion criteria included the following: 1. a minimum of a 2-year follow-up or failure of treatment within this period; 2. complete record of serum biomarkers; and 3. met the Musculoskeletal Infection Society criteria (MSIS) when diagnosed PJI. Serum biomarkers and organism results at the onset of PJI diagnosis and reimplantation were reviewed. Treatment success was defined according to the Delphi consensus criteria with a minimum follow-up of 2 years, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in four serum markers for predicting failure. Results When predicting persistent PJI, the area under the ROC curves (AUC) demonstrated that both the percent change and value change of serum markers were poor indicators. When comparing exact values of serum markers during reimplantation, the values of CRP and fibrinogen were significant higher in reinfection group. Besides, initial causative organism didn’t influence the normalize of serum markers. Conclusion Either the value change or percent change of serum markers were not useful for determining the timing of reimplantation, and initial causative organism didn’t influence the normalize of serum markers. Persistent PJI after TJA was still difficult to diagnose.

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Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection

Cited by 133 publications

References 25 publications

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

Change in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange ArthroplastyChange in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty

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