Center for Musculoskeletal Surgery, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Arch Orthop Trauma Surg. 2023 Apr;143(4):1855-1860. doi: 10.1007/s00402-022-04385-6. Epub 2022 Feb 19.
D-Dimer was recently identified as an additional biomarker in the diagnosis of hip and knee periprosthetic joint infection (PJI). Currently, there is only one study in literature dealing with the role of D-Dimer in the diagnosis of shoulder PJI. The purpose of this study was, therefore, to validate the sensitivity and specificity of D-Dimer in detecting shoulder PJI.
All patients, who underwent septic or aseptic revision shoulder arthroplasty in our institution between November 2018 und March 2021, were analyzed. Our cohort consisted of 30 patients, of that 14 (47%) had a shoulder PJI according the last proposed criteria of the International Consensus Meeting. The diagnostic validity of serum D-Dimer regarding the detection of PJI was analyzed.
The mean D-Dimer level was significantly higher for the patients with shoulder PJI compared to patients with aseptic failure (1.44 ± 1 mg/l vs. 0.76 ± 0.6 mg/l, p = 0.025). Coagulase-negative staphylococci were the most commonly isolated pathogens, in 9/14 patients (64%), followed by Cutibacterium acnes in 5/14 patients (36%). According to the ROC analysis, a serum D-Dimer threshold of 0.75 mg/l had a sensitivity of 86% and a specificity of 56% for detection of a shoulder PJI. The area under curve was 0.74. A serum C-reactive protein (CRP) cutoff of 10 mg/l showed a sensitivity of 69% and a specificity of 88%. When both serum D-Dimer and CRP above the thresholds of 0.75 mg/l and 10 mg/l, respectively, were used to identify a PJI the sensitivity and specificity were 57% and 100%, respectively.
Serum D-Dimer showed a good sensitivity but a poor specificity for the diagnosis of shoulder PJI. Combination D-Dimer and CRP led to improvement of the specificity, however, at the cost of sensitivity. Thus, combination of both methods may be used as a confirmatory test in the diagnosis of shoulder PJI but not to rule out infection.
Diagnostic level II.
D-二聚体最近被确定为髋关节和膝关节假体周围关节感染（PJI）诊断的附加生物标志物。目前，文献中仅有一项关于 D-二聚体在肩关节 PJI 诊断中的作用的研究。因此，本研究的目的是验证 D-二聚体在检测肩关节 PJI 中的灵敏度和特异性。
分析了 2018 年 11 月至 2021 年 3 月期间在我院接受感染或无菌翻修肩关节置换术的所有患者。我们的队列包括 30 名患者，其中 14 名（47%）根据国际共识会议的最新提出的标准患有肩关节 PJI。分析了血清 D-二聚体检测 PJI 的诊断有效性。
与无菌失败患者相比，患有肩关节 PJI 的患者的 D-二聚体水平明显更高（1.44±1mg/l 与 0.76±0.6mg/l，p=0.025）。凝固酶阴性葡萄球菌是最常见的分离病原体，14 例患者中有 9 例（64%），14 例患者中有 5 例（36%）为痤疮丙酸杆菌。根据 ROC 分析，血清 D-二聚体阈值为 0.75mg/l 时，对肩关节 PJI 的敏感性为 86%，特异性为 56%。曲线下面积为 0.74。血清 C 反应蛋白（CRP）截断值为 10mg/l 时，敏感性为 69%，特异性为 88%。当血清 D-二聚体和 CRP 分别超过 0.75mg/l 和 10mg/l 的阈值时，用于识别 PJI 的敏感性和特异性分别为 57%和 100%。
血清 D-二聚体对肩关节 PJI 的诊断具有良好的敏感性，但特异性较差。D-二聚体和 CRP 的联合使用提高了特异性，但降低了敏感性。因此，两种方法的联合可作为肩关节 PJI 的确诊试验，但不能排除感染。
诊断水平 II。
