| Objectives:Diagnosis of periprosthetic infection(PJI)after prosthetic joint arthroplasty remains challenging,and joint periprosthetic infection is one of the most serious complications after primary prosthetic joint arthroplasty,posing a significant burden on patients.And early definite diagnosis of joint periprosthetic infection has important implications in the course of treatment in the clinic.Recently,fibrinogen(FIB)has been shown to be closely associated with infection and inflammation.However,studies on the diagnostic value of fibrinogen for joint peri-prosthetic infections are still scarce.This study evaluates fibrinogen for its use in the diagnosis of joint periprosthetic infection by collecting the results of tests for fibrinogen,while the results of traditional inflammatory markers such as C-reactive protein,erythrocyte sedimentation rate,and calcitonin are collected and compared to analyze whether there are differences in sensitivity and specificity between the above indicators for the diagnosis of joint periprosthetic infection Clinical value.Methods:Through retrospective analysis of patient medical record information of 123 patients who underwent revision surgery for total hip or total knee arthroplasty at the Department of joint surgery of a certain hospital from January 2017 to June 2020,123 patients who underwent revision surgery for total hip or knee arthroplasty were finally included in this study according to the inclusion and exclusion criteria,and 87 patients were finally enrolled in this study according to the guidelines of the bone and muscle Infection Society(musculoskeletal infection society,MSIS)criteria to group patients,37 in the group A patients with a definite diagnosis of periprosthetic infection and 50 in the group B patients with non periprosthetic infection.Among the patients diagnosed with periprosthetic infection,a total of 20 patients had hip periprosthetic infection and 17 patients had knee periprosthetic infection.Results:Compared with group B,CRP,ESR,and FIB levels were significantly higher in group A(P < 0.001).The fibrinogen AUC area was 0.915(95% CI,0.854-0.975),which was slightly lower than the values of 0.934(95% CI,0.879-0.988)for CRP and 0.942(95% CI,0.879-0.986)for ESR,but lower than the value of 0.968(95% CI,0.936-1.000)for the combined diagnosis of all three.The optimal cut-off value for FIB was 3.94 g / L,and its sensitivity,specificity,PPV,NPV,+LR,-LR were 91.9%,84%,81.0%,93.3%,5.74,0.26.The optimal cut-off value for CRP was 16.99mg/l,and its sensitivity,specificity,PPV,NPV,+ LR,+ LR,and-LR were 83.8%,94%,91.2%,90.4%,13.96,and0.09.ESR was determined using 23.50 mm / h as the optimal cut-off value,and its sensitivity,specificity,PPV,NPV,+ LR,and-LR were86.5%,84.00%,80.0%,89.4%,5.40,and 0.26,respectively.However,PCT had a low diagnostic value with an optimal cut-off value of0.428mg/l,a sensitivity of only 56.8% and a specificity of 86% with PPV,NPV,+ LR,-LR of 75.0%,72.9%,4.05,0.22,respectively.The three combined diagnostic sequence tests had a sensitivity of 72.97%,specificity of 100%,positive predictive value of 100% and negative predictive value of 83.3%.Among the parallel tests,the sensitivity was97.30%,the specificity was 70%,the positive predictive value was70.59%,and the negative predictive value was 97.22%.Combined diagnosis of multiple indicators,the sensitivity was 83.8%,the specificity was 100%,the positive predictive value was 100%,the negative predictive value was 89.29%。Conclusion:FIB has a high diagnostic value for the diagnosis of periprosthetic infection after artificial joint replacement.Its diagnostic value is similar to CRP and ESR,and it has the advantages of convenient examination and low cost.FIB is expected to be a new diagnostic marker for the diagnosis of PJI,and the diagnostic value is higher when the three factors are combined in the diagnosis of PJI.However,PCT has limited diagnostic value for PJI and is not recommended for routine preoperative examination. |
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