Diagnostic Value Of ESR/CRP,D-Dimer And Fibrinogen In Knee Joint Periprosthetic Joint Infection

Objective:To investigate the diagnostic value of erythrocyte sedimentation rate to C-reflective protein(ECR),fibrinogen(FIB)and D-dimer in periprosthetic joint infection after total knee arthroplasty.Methods:A total of 205 patients,including 62 males and 143females,aged(66.9±9.5)years(range 26-84 years),who underwent revision of artificial knee joint at Department of Joint Surgery,The First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2021 were retrospectively collected.122 cases of periprosthetic joint infection(PJI),including 43 cases of acute infection;79 cases of chronic infection(13 cases of chronic infection combined with rheumatoid arthritis were analyzed separately);There were 83 cases without PJI,including73 cases of aseptic loosening,8 cases of prosthesis dislocation and 2 cases of joint stiffness.ESR,CRP,WBC,FIB and D-dimer levels were examined before surgery,and the sensitivity and specificity of the indicators were calculated using the receiver operating characteristic(ROC)curve.The diagnostic value of different inflammatory markers was compared according to the area under curve(AUC).Results:Compared with the non-PJI group,the levels of ECR,ESR,CRP,FIB and D-dimer in acute and chronic PJI groups were significantly increased(P<0.05).Acute PJI group the WBC of no statistical significance(P>0.05);the area under the curve of ECR,ESR,CRP,FIB,D-dimer in acute PJI group were 0.82,0.85,0.90,0.88,and 0.76,respectively.According to the Youden index,the optimal critical values of ECR,ESR,CRP,FIB and D-dimer are 2.89,37.00mm/1h,13.6 mg/L,3.86 g/L and 443.0 ng/m L,respectively,with sensitivity of 76.7%,79.1%,76.7%,69.8%and 82.4%,and specificity of 79.5%,78.3%,94.0%,90.4%and63.8%,respectively.The area under the curve of ECR,ESR,CRP,FIB,D-dimer,and WBC in chronic PJI group were 0.77,0.82,0.87,0.85,0.67,and 0.63,respectively;The optimal critical values were 2.91,33.00 mm/1h,10.9 mg/L,4.01 g/L,558.5 ng/m L,5.575×10~9/L,respectively.The sensitivity was 68.2%,78.8%,81.8%,63.6%,57.9%,75.8%,and the specificity were 79.5%,73.5%,88.0%,95.2%,72.5%,49.4%,respectively.Conclusion:Fibrinogen has a higher diagnostic value for knee joint PJI,followed by ECR,and D-dimer has the lowest diagnostic value for knee joint PJI.