Background: 

No single test has demonstrated absolute accuracy in the diagnosis of periprosthetic joint infection (PJI). Serological markers are often used as screening tools in the workup of patients with suspected PJI. This study aimed to determine the diagnostic utility of plasma D-dimer for PJI in a variety of clinical scenarios.

Methods: 

This prospective study enrolled 502 patients undergoing revision hip or knee arthroplasty. PJI was defined per a modified version of the 2018 International Consensus Meeting (ICM) criteria. Plasma D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen were measured preoperatively. Receiver operating characteristic curves were used to assess the utility of each biomarker in the diagnosis of PJI. Pairwise comparison with Bonferroni correction was performed to determine whether the differences in areas under the curve (AUCs) between the markers were significant.

Results: 

Of the 412 patients included, 317 (76.9%) did not have an infection (aseptic group) and 95 (23.1%) had an infection (PJI group). All 4 serological markers, D-dimer (AUC, 0.860; sensitivity, 81.3%; specificity, 81.7%), CRP (AUC, 0.862; sensitivity, 90.4%; specificity, 70.0%), ESR (AUC, 0.833; sensitivity, 73.9%; specificity, 85.2%), and fibrinogen (AUC, 0.798; sensitivity, 74.7%; specificity, 75.4%), demonstrated comparable accuracy for the diagnosis of PJI (all p > 0.05). When examining the performance of the different inflammatory markers in diagnosing infection caused by indolent organisms, D-dimer demonstrated the highest sensitivity at 93.8%.

Conclusions: 

We found that plasma D-dimer was noninferior to serum CRP and ESR in the diagnosis of PJI and may be a useful adjunct when screening patients undergoing revision total joint arthroplasty.

Level of Evidence: 

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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血浆 D-二聚体在诊断假体周围感染方面不劣于血清 C 反应蛋白

背景： 

没有任何一项测试能够证明假体周围感染 (PJI) 诊断的绝对准确性。血清学标志物通常用作疑似 PJI 患者检查中的筛查工具。本研究旨在确定血浆 D-二聚体在各种临床情况下对 PJI 的诊断效用。

方法： 

这项前瞻性研究招募了 502 名接受髋关节或膝关节翻修术的患者。PJI 是根据 2018 年国际共识会议 (ICM) 标准的修改版本定义的。术前测定血浆D-二聚体、红细胞沉降率（ESR）、C反应蛋白（CRP）和纤维蛋白原。受试者工作特征曲线用于评估每种生物标志物在 PJI 诊断中的效用。与 Bonferroni 校正进行配对比较，以确定标记物之间曲线下面积 (AUC) 的差异是否显着。

结果： 

在纳入的 412 名患者中，317 名（76.9%）没有感染（无菌组），95 名（23.1%）有感染（PJI 组）。所有 4 种血清学标志物，D-二聚体（AUC，0.860；敏感性，81.3%；特异性，81.7%）、CRP（AUC，0.862；敏感性，90.4%；特异性，70.0%）、ESR（AUC，0.833；敏感性，73.9） %；特异性，85.2%）和纤维蛋白原（AUC，0.798；敏感性，74.7%；特异性，75.4%），显示了 PJI 诊断的相当的准确性（所有 p > 0.05）。在检查不同炎症标志物在诊断惰性微生物引起的感染中的表现时，D-二聚体表现出最高的敏感性，为 93.8%。

结论： 

我们发现血浆 D-二聚体在 PJI 的诊断中不劣于血清 CRP 和 ESR，并且在筛选接受翻修全关节置换术的患者时可能是一个有用的辅助手段。

证据级别： 

诊断级别 II。有关证据级别的完整描述，请参阅作者须知。