Chen Xi, Li Hairui, Zhu Shibai, Wang Yiou, Qian Wenwei
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Bone Joint Res. 2020 Oct;9(10):701-708. doi: 10.1302/2046-3758.910.BJR-2020-0172.R2.
The diagnosis of periprosthetic joint infection (PJI) has always been challenging. Recently, D-dimer has become a promising biomarker in diagnosing PJI. However, there is controversy regarding its diagnostic value. We aim to investigate the diagnostic value of D-dimer in comparison to ESR and CRP.
PubMed, Embase, and the Cochrane Library were searched in February 2020 to identify articles reporting on the diagnostic value of D-dimer on PJI. Pooled analysis was conducted to investigate the diagnostic value of D-dimer, CRP, and ESR.
Six studies with 1,255 cases were included (374 PJI cases and 881 non-PJI cases). Overall D-dimer showed sensitivity of 0.80 (95% confidence interval (CI) 0.69 to 0.87) and specificity of 0.76 (95% CI 0.63 to 0.86). Sub-group analysis by excluding patients with thrombosis and hyper-coagulation disorders showed sensitivity of 0.82 (95% CI 0.70 to 0.90) and specificity of 0.80 (95% CI 0.70 to 0.88). Serum D-dimer showed sensitivity of 0.85 (95% CI 0.76 to 0.92), specificity of 0.83 (95% CI 0.74 to 0.90). Plasma D-dimer showed sensitivity of 0.67 (95% CI 0.60 to 0.73), specificity of 0.58 (95% CI 0.45 to 0.72). CRP showed sensitivity of 0.78 (95% CI 0.72 to 0.83), specificity of 0.81 (95% CI 0.72 to 0.87). ESR showed sensitivity of 0.68 (95% CI 0.63 to 0.73), specificity of 0.83 (95% CI 0.78 to 0.87).
In patients without thrombosis or a hyper-coagulation disorder, D-dimer has a higher diagnostic value compared to CRP and ESR. In patients with the aforementioned conditions, D-dimer has higher sensitivity but lower specificity compared to ESR and CRP. We do not recommend the use of serum D-dimer in patients with thrombosis and hyper-coagulation disorders for diagnosing PJI. Serum D-dimer may perform better than plasma D-dimer. Further studies are needed to compare serum D-dimer and plasma D-dimer in arthroplasty patients. Cite this article: 2020;9(10):701-708.
人工关节周围感染（PJI）的诊断一直具有挑战性。近年来，D - 二聚体已成为诊断PJI的一种有前景的生物标志物。然而，其诊断价值存在争议。我们旨在研究D - 二聚体与红细胞沉降率（ESR）和C反应蛋白（CRP）相比的诊断价值。
于2020年2月检索了PubMed、Embase和Cochrane图书馆，以识别报告D - 二聚体对PJI诊断价值的文章。进行荟萃分析以研究D - 二聚体、CRP和ESR的诊断价值。
纳入了6项研究，共1255例病例（374例PJI病例和881例非PJI病例）。总体而言，D - 二聚体的敏感性为0.80（95%置信区间（CI）0.69至0.87），特异性为0.76（95%CI 0.63至0.86）。排除有血栓形成和高凝疾病患者的亚组分析显示，敏感性为0.82（95%CI 0.70至0.90），特异性为0.80（95%CI 0.70至0.88）。血清D - 二聚体的敏感性为0.85（95%CI 0.76至0.92），特异性为0.83（95%CI 0.74至0.90）。血浆D - 二聚体的敏感性为0.67（95%CI 0.60至0.73），特异性为0.58（95%CI 0.45至0.72）。CRP的敏感性为0.78（95%CI 0.72至0.83），特异性为0.81（95%CI 0.72至0.87）。ESR的敏感性为0.68（95%CI 0.63至0.73），特异性为0.83（95%CI 0.78至0.87）。
在没有血栓形成或高凝疾病的患者中，D - 二聚体比CRP和ESR具有更高的诊断价值。在患有上述疾病的患者中，与ESR和CRP相比，D - 二聚体具有更高的敏感性但特异性较低。我们不建议在有血栓形成和高凝疾病的患者中使用血清D - 二聚体来诊断PJI。血清D - 二聚体可能比血浆D - 二聚体表现更好。需要进一步研究比较关节置换患者的血清D - 二聚体和血浆D - 二聚体。引用本文：2020；9(10):701 - 708。
