Plasma D-Dimer Can Diagnose Periprosthetic Joint Infection

Plasma D-dimer had comparable accuracy to CRP, ESR, fibrinogen for diagnosing periprosthetic joint infection in patients with revision hip or knee arthroplasty

HealthDay News — Plasma D-dimer is noninferior to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for diagnosing periprosthetic joint infection (PJI) among patients undergoing revision hip or knee arthroplasty, according to a study published online February 9 in the Journal of Bone & Joint Surgery.

Saad Tarabichi, MD, from the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, and colleagues conducted a prospective study involving 502 patients undergoing revision hip or knee arthroplasty to examine the diagnostic utility of plasma D-dimer for PJI. Plasma D-dimer, ESR, CRP, and fibrinogen were measured preoperatively, and their utility in the diagnosis of PJI was assessed.

The researchers found that 317 of 412 patients included (76.9%) did not have an infection, while 95 (23.1%) had PJI. The four biomarkers had comparable accuracy for the diagnosis of PJI. Area under the curve, sensitivity, and specificity, respectively, were: 0.860, 81.3%, and 81.7% for D-dimer; 0.862, 90.4%, and 70.0% for CPR; 0.833, 73.9%, and 85.2% for ESR; and 0.798, 74.7%, and 75.4% for fibrinogen. D-dimer demonstrated the highest sensitivity at 93.8% for diagnosing infection caused by indolent organisms.

“We found that plasma D-dimer was noninferior to serum CRP and ESR and may be a useful adjunct when screening patients undergoing revision [total joint arthroplasty],” the authors write. “However, due to heterogeneity in the measurement of D-dimer levels, the application of a universal diagnostic threshold is not currently recommended.”

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