The Diagnostic Value And Accuracy Of D-dimer In Periprosthetic Joint Infection:A Systematic Review And Meta-analysis

Objective:There is still no single indicator or even a combination of indicators that can definitely confirm or exclude periprosthetic joint infection(PJI).D-dimer has recently emerged as a novel index for the diagnosis of PJI,but its reliability is uncertain.We aimed to determine the diagnostic value and accuracy of D-dimer in detecting PJI.Methods:We conducted a systematic search and screening to identify relevant articles from online register databases such as PubMed,Embase,Web of Science,and the Cochrane Library.QUADAS-2 was used to assess the quality of each included study.The bivariate mixed-effects regression model was used to combine sensitivity,specificity,likelihood ratio(LR),diagnostic odds ratio(DOR),summary receiver operating characteristic curve(SROC),and area under SROC(AUC)to evaluate the diagnostic value of overall D-dimer for PJI.Univariate meta-regression and subgroup analysis were performed to explore the sources of heterogeneity.Results:A total of 11 studies were included in our study,including 1645 patients.The pooled sensitivity and specificity of D-dimer for PJI diagnosis were 0.80(95%CI:0.72～0.87)and 0.74(95%CI:0.62～0.83),respectively.The pooled positive likelihood ratio(PLR),negative likelihood ratio(NLR),DOR and AUC were 3.04(95%CI:2.01～4.61),0.27(95%CI:0.18～0.40),11.40(95%CI:5.50～23.63),and 0.84(95%CI:0.81～0.87),respectively.Subgroup outcomes showed serum D-dimer had a higher diagnostic accuracy than plasma D-dimer for PJI(pooled sensitivity:0.88 vs.0.67;pooled specificity:0.78 vs.0.67;pooled AUC:0.91 vs.0.68).Conclusion:Serum D-dimer had a promising performance for the diagnosis of PJI,which was shown to have a better diagnostic value than plasma Ddimer.