低毒力人工关节感染的旋转血栓弹力图诊断准确性：一项初步研究

Diagnostic Accuracy of Rotational Thromboelastometry for Low-Virulence Periprosthetic Joint Infections: A Pilot Study.

作者信息

Tsantes Andreas G, Domouchtsidou Aglaia, Tsante Konstantina A, Ioannou Petros, Mpakosi Alexandra, Petrou Eleni, Goumenos Stavros, Trikoupis Ioannis G, Roustemis Anastasios G, Fortis Sotirios P, Koutserimpas Christos, Papagelopoulos Panayiotis J, Samonis George, Bonovas Stefanos, Papadopoulos Dimitrios V

机构信息

Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.

Microbiology Department, "Saint Savvas" Oncology Hospital, 11522 Athens, Greece.

出版信息

Microorganisms. 2024 Aug 22;12(8):1740. doi: 10.3390/microorganisms12081740.

DOI:10.3390/microorganisms12081740

PMID:39203582

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11357059/

Abstract

BACKGROUND

Periprosthetic joint infections (PJIs) are associated with altered coagulation dynamics; therefore, coagulation laboratory studies could be valuable for diagnosing PJI. This study aimed to evaluate the diagnostic role of Rotational Thromboelastometry (ROTEM) in detecting PJIs caused by low-virulence pathogens.

METHODS

A retrospective study was conducted, enrolling 78 patients who underwent exchange arthroplasty due to PJI due to high-virulence pathogens (Group A, = 16), low-virulence pathogens (Group B, = 20), or due to aseptic loosening (Group C, = 20). Preoperative laboratory findings were compared among the three groups.

RESULTS

Several ROTEM parameters differed in patients with PJIs caused by low-virulence pathogens, indicating a link between these infections and hypercoagulability. The development of low-virulence PJIs was associated with a higher maximum clot firmness (MCF) (Odds Ratio, 1.12; 95% Confidence Interval, 1.04-1.21; = 0.001). Additionally, EXTEM MCF was found to have the highest diagnostic accuracy for these infections (Area Under the Curve, 0.841; sensitivity 90.0%; specificity 90.4%), surpassing that of C-reactive protein and the Erythrocyte Sedimentation Rate ( = 0.006 and = 0.019, respectively).

CONCLUSIONS

Our findings suggest that ROTEM analysis is a promising method for detecting the altered hemostatic dynamics associated with PJI caused by low-virulence pathogens.

摘要

背景

人工关节周围感染（PJI）与凝血动力学改变有关；因此，凝血实验室检查对PJI的诊断可能具有重要价值。本研究旨在评估旋转血栓弹力图（ROTEM）在检测低毒力病原体引起的PJI中的诊断作用。

方法

进行了一项回顾性研究，纳入78例因高毒力病原体（A组，n = 16）、低毒力病原体（B组，n = 20）或无菌性松动（C组，n = 20）导致的PJI而接受关节置换术的患者。比较三组患者术前的实验室检查结果。

结果

低毒力病原体引起的PJI患者的几个ROTEM参数有所不同，表明这些感染与高凝状态之间存在联系。低毒力PJI的发生与更高的最大血凝块硬度（MCF）相关（比值比，1.12；95%置信区间，1.04 - 1.21；P = 0.001）。此外，发现EXTEM MCF对这些感染具有最高的诊断准确性（曲线下面积，0.841；敏感性90.0%；特异性90.4%），超过了C反应蛋白和红细胞沉降率（分别为P = 0.006和P = 0.019）。