Balato Giovanni, De Franco Cristiano, Balboni Fiamma, De Matteo Vincenzo, Ascione Tiziana, Baldini Andrea, Lippi Giuseppe
Department of Public Health, Orthopedic Unit, Federico II University Naples, Naples, Italy.
Laboratory Service, Istituto Fiorentino Cura e Assistenza IFCA Florence, Florence, Italy.
Diagnosis (Berl). 2021 May 19;9(1):3-10. doi: 10.1515/dx-2021-0032.
The current literature on diagnosis of periprosthetic joint infection (PJI) provides controversial evidence on the diagnostic accuracy of D-dimer. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of D-dimer for diagnosing PJI.
We searched MEDLINE, Scopus, and Web of Science, for studies on D-dimer for diagnosing PJI, according to the PRISMA flowchart. QUADAS was used for assessing study quality. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed using bivariate diagnostic random-effects model. The area under the receiver-operating curve (AUC-ROC) was calculated. Subgroup analysis and univariate meta-regression were carried out for detecting potential sources of heterogeneity.
We included 12 articles, totaling 1,818 patients (539 with PJI). The pooled sensitivity and specificity of D-dimer for diagnosing PJI were 0.739 (95% CI: 0.616-0.833) and 0.785 (95% CI: 0.679-0.863). The pooled PLR, NLR, DOR were 3.359 (95% CI, 2.340-4.821), 0.295 (95% CI, 0.180-0.484), and 11.787 (95% CI, 5.785-24.018). The cumulative ROC plot displayed an AUC of 0.688 (95% CI, 0.663-0.713; p<0.001). No threshold effects could be observed. The type of blood sample was identified as possible source of heterogeneity for DOR (p=0.01).
Evidence emerged from this meta-analysis suggests that D-dimer displays sufficient diagnostic accuracy to rule out PJI. The type of blood sample (plasma vs. serum) and the study design could influence the results in terms of DOR and sensitivity. However, further perspective studies would be needed to validate its potential diagnostic usefulness.
目前关于人工关节周围感染（PJI）诊断的文献对于D - 二聚体的诊断准确性提供了有争议的证据。因此，本次关键文献检索和荟萃分析旨在总结D - 二聚体对PJI的诊断准确性。
我们根据PRISMA流程图在MEDLINE、Scopus和Web of Science中检索关于D - 二聚体诊断PJI的研究。使用QUADAS评估研究质量。采用双变量诊断随机效应模型分析敏感性、特异性、阳性似然比（PLR）和阴性似然比（NLR）以及诊断比值比（DOR）。计算受试者工作特征曲线下面积（AUC - ROC）。进行亚组分析和单变量meta回归以检测潜在的异质性来源。
我们纳入了12篇文章，共1818例患者（539例PJI患者）。D - 二聚体诊断PJI的合并敏感性和特异性分别为0.739（95%CI：0.616 - 0.833）和0.785（95%CI：0.679 - 0.863）。合并的PLR、NLR、DOR分别为3.359（95%CI，2.340 - 4.821）、0.295（95%CI，0.180 - 0.484）和11.787（95%CI，5.785 - 24.018）。累积ROC曲线显示AUC为0.688（95%CI，0.663 - 0.713；p<0.001）。未观察到阈值效应。血样类型被确定为DOR异质性的可能来源（p = 0.01）。
该荟萃分析得出的证据表明，D - 二聚体在排除PJI方面显示出足够的诊断准确性。血样类型（血浆与血清）和研究设计可能会在DOR和敏感性方面影响结果。然而，需要进一步的前瞻性研究来验证其潜在的诊断效用。
