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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2021

Open Access 01-12-2021 | Joint Infection | Research article

Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials

Authors: Liping Pan, Hao Wu, Heng Liu, Xin Yang, Zhichao Meng, Yongping Cao

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2021

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Abstract

Purpose

D-dimer and fibrinogen, both belonging to coagulation parameters, are controversial for the diagnosis of periprosthetic joint infection (PJI). This meta-analysis was conducted to compare their diagnostic accuracies for PJI by synthesizing currently available evidence.

Methods

Cochrane Library, MEDLINE, Web of Science, and Embase up to March 1, 2020, and other relevant articles were searched. Five hundred and eighty-one articles were identified after initial research, and 11 studies were included finally. No threshold effects were found between studies. The pooled sensitivity, specificity, and positive and negative likelihood ratio were reported to evaluate the diagnostic performance with heterogeneity analysis. Z test statistics was used to analyze the difference of diagnostic performance between D-dimer and fibrinogen.

Results

The pooled sensitivity, specificity, and positive and negative likelihood ratio of D-dimer for PJI were 0.79 (95% [CI], 0.72–0.85), 0.77 (0.67–0.84), 3.38 (2.21–5.18), and 0.27 (0.18–0.41), respectively. As for fibrinogen, the pooled sensitivity, specificity, and positive and negative likelihood ratio for PJI were 0.75 (0.68–0.80), 0.85 (0.82–0.88), 5.12 (4.22–6.22), and 0.30 (0.23–0.37), respectively. Great heterogeneity was found in studies for D-dimer, and univariate meta-regression analysis revealed that number of involved joints, disease spectrum, comorbidities influencing D-dimer, and sample sources were the source of heterogeneity. Z test found that the pooled specificity of fibrinogen was significantly higher than D-dimer (0.85 ± 0.01 versus 0.77 ± 0.04, p = 0.03). The pooled positive likelihood ratio of fibrinogen was significantly higher than D-dimer (5.12 ± 0.51 versus 3.38 ± 0.74, p = 0.03).

Conclusion

Based on currently available evidence, the meta-analysis suggests that fibrinogen performs better than D-dimer as a rule-in diagnostic tool for its higher specificity. However, more prospective trials with larger size are still needed to provide further confirmation.

Trial registration

This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews), and the registering number was CRD42020177176.
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Metadata
Title
Fibrinogen performs better than D-dimer for the diagnosis of periprosthetic joint infection: a meta-analysis of diagnostic trials
Authors
Liping Pan
Hao Wu
Heng Liu
Xin Yang
Zhichao Meng
Yongping Cao
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Joint Infection
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2021
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-020-02109-3

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