D-dimer in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.
BACKGROUND
D-dimer, a coagulation-related indicator, has recently been used as a tool for the diagnosis of periprosthetic joint infection (PJI), but its reliability is uncertain. The purpose of this systematic review and meta-analysis was to explore the accuracy of D-dimer in the diagnosis of PJI after joint arthroplasty.


METHODS
We systematically searched the MEDLINE, EMBASE, and Cochrane databases for relevant literature about D-dimer in the diagnosis of PJI. QUADAS-2 was used to assess the risk of bias and clinical applicability of each included study. We used the bivariate meta-analysis framework to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the SROC curve (AUC). Univariate meta-regression and subgroup analyses were performed to explore the sources of heterogeneity.


RESULTS
We included 8 eligible studies. The pooled diagnostic sensitivity and specificity were 0.82 (95% CI, 0.70-0.89) and 0.70 (95% CI, 0.55-0.82), respectively. The pooled PLR, NLR, and DOR were 2.7 (95% CI, 1.7-4.4), 0.26 (95% CI, 0.15-0.46), and 10 (95% CI, 4-25), respectively. The AUC was 0.83 (95% CI, 0.8-0.86). Serum D-dimer might have higher diagnostic accuracy than plasma D-dimer for PJI (pooled sensitivity: 0.88 vs 0.67; pooled specificity: 0.76 vs 0.61).


CONCLUSIONS
D-dimer has limited performance for the diagnosis of PJI.
['Lu|Guangxu|G|', 'Li|Tong|T|', 'Ye|Haoqi|H|', 'Liu|Shujin|S|', 'Zhang|Peng|P|', 'Wang|Wenliang|W|http://orcid.org/0000-0002-1726-7698']
D000368:Aged D001168:Arthritis D001178:Arthroplasty D015415:Biomarkers D005260:Female D005338:Fibrin Fibrinogen Degradation Products D006801:Humans D008297:Male D008875:Middle Aged D016459:Prosthesis-Related Infections D012680:Sensitivity and Specificity
D-dimer Diagnosis Periprosthetic joint infection Meta-analysis Arthroplasty