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Combined measurement of D-dimer and C-reactive protein levels: Highly accurate for diagnosing chronic periprosthetic joint infection

Journal of Arthroplasty Aug 19, 2019

Qin L, et al. - A total of 122 individuals presenting with a painful knee or hip following THA or TKA for surgical revision were involved in a prospective trial by the experts in order to examine the sensitivity and specificity of plasma levels of D-dimer in detecting chronic periprosthetic joint infection (PJI), and to enhance the exactitude of chronic PJI diagnosis through combined measurement of serum D-dimer with CRP/ESR. The AUC for D-dimer was 0.915, was more reliable vs serum ESR 0.719 and serum CRP 0.761. In the diagnosis of chronic PJI, with a sensitivity of 92.73% and a specificity of 74.63%, the optimal threshold value of plasma D-dimer for the diagnosis of chronic PJI was discovered to be 1,170 ng/mL using the Youden index. For the diagnosis of chronic PJI, the combination of D-dimer (> 1,170 ng/ml) and CRP (> 7.54 mg/L) tests exhibited a sensitivity of 98.11% and NPV of 96.55% and diagnostic odds ratio of 33.80. Hence, for diagnostics of chronic PJI, the cut-off values of 1,170 ng/mL for D-dimer were recognized. The combination of serum D-dimer and CRP/ESR resulted in the betterment of sensitivity in comparison with those of the single index test. Simultaneous positivity of serum D-dimer and CRP could exclude 96.55% false-negative discovery of chronic PJI.
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