The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection

Abstract D-dimer has been included in the criteria by the Musculoskeletal Infection Society in 2018 as a novel parameter to diagnose prosthetic joint infection (PJI). However, it is unclear how D-dimer levels change in between stages of a two-stage exchange. We prospectively investigated 30 patients...

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Autores principales:	Thomas Ackmann, Jan Schwarze, Georg Gosheger, Tom Schmidt-Braekling, Kristian Nikolaus Schneider, Ralf Dieckmann, Sebastian Klingebiel, Burkhard Moellenbeck, Christoph Theil
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/389b258bba9f4eaca52ce80c2b8c3afb
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spelling	oai:doaj.org-article:389b258bba9f4eaca52ce80c2b8c3afb2021-12-02T13:26:37ZThe change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection10.1038/s41598-021-86890-z2045-2322https://doaj.org/article/389b258bba9f4eaca52ce80c2b8c3afb2021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86890-zhttps://doaj.org/toc/2045-2322Abstract D-dimer has been included in the criteria by the Musculoskeletal Infection Society in 2018 as a novel parameter to diagnose prosthetic joint infection (PJI). However, it is unclear how D-dimer levels change in between stages of a two-stage exchange. We prospectively investigated 30 patients who underwent a two-stage exchange using a spacer for PJI. D-Dimer, CRP and IL-6 were collected before first and second stage surgery and the difference (Δ) in between stages was calculated. The levels of plasma D-Dimer did not change from first to second stage surgery (2770 ng/ml (IQR, 1600–3770 ng/ml) versus 2340 ng/ml (IQR, 1270–4100 ng/ml); p = 0.8) while CRP (4.0 mg/dl (IQR, 1.7–5.5 mg/dl) versus 0.6 mg/dl (IQR, 0.5–0.8 mg/dl); p < 0.001) and IL-6 (21 pg/ml (IQR, 10–29 pg/ml) versus 6 pg/ml (4–9 pg/ml); p < 0.001) decreased. The ΔD-dimer between both stages was 300 ng/ml (range: − 2820 to 4280 ng/ml), the median ΔCRP was − 3.4 mg/dl (IQR, − 1.2 to − 4.8 mg/dl) and ΔIL-6 was − 13 pg/ml (IQR, − 4 to − 20 pg/ml). In 15 of 30 cases (50%) the D-dimer level increased between both stages, whereas the level of CRP (93%; 28/30) and IL-6 (96%; 28/29) decreased in most patients. As the level of serum D-dimers varies greatly, lacks a uniform decrease and does not identify persisting infection, surgeons should be cautious when using it at the timing of reimplantation.Thomas AckmannJan SchwarzeGeorg GoshegerTom Schmidt-BraeklingKristian Nikolaus SchneiderRalf DieckmannSebastian KlingebielBurkhard MoellenbeckChristoph TheilNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Thomas Ackmann Jan Schwarze Georg Gosheger Tom Schmidt-Braekling Kristian Nikolaus Schneider Ralf Dieckmann Sebastian Klingebiel Burkhard Moellenbeck Christoph Theil The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
description	Abstract D-dimer has been included in the criteria by the Musculoskeletal Infection Society in 2018 as a novel parameter to diagnose prosthetic joint infection (PJI). However, it is unclear how D-dimer levels change in between stages of a two-stage exchange. We prospectively investigated 30 patients who underwent a two-stage exchange using a spacer for PJI. D-Dimer, CRP and IL-6 were collected before first and second stage surgery and the difference (Δ) in between stages was calculated. The levels of plasma D-Dimer did not change from first to second stage surgery (2770 ng/ml (IQR, 1600–3770 ng/ml) versus 2340 ng/ml (IQR, 1270–4100 ng/ml); p = 0.8) while CRP (4.0 mg/dl (IQR, 1.7–5.5 mg/dl) versus 0.6 mg/dl (IQR, 0.5–0.8 mg/dl); p < 0.001) and IL-6 (21 pg/ml (IQR, 10–29 pg/ml) versus 6 pg/ml (4–9 pg/ml); p < 0.001) decreased. The ΔD-dimer between both stages was 300 ng/ml (range: − 2820 to 4280 ng/ml), the median ΔCRP was − 3.4 mg/dl (IQR, − 1.2 to − 4.8 mg/dl) and ΔIL-6 was − 13 pg/ml (IQR, − 4 to − 20 pg/ml). In 15 of 30 cases (50%) the D-dimer level increased between both stages, whereas the level of CRP (93%; 28/30) and IL-6 (96%; 28/29) decreased in most patients. As the level of serum D-dimers varies greatly, lacks a uniform decrease and does not identify persisting infection, surgeons should be cautious when using it at the timing of reimplantation.
format	article
author	Thomas Ackmann Jan Schwarze Georg Gosheger Tom Schmidt-Braekling Kristian Nikolaus Schneider Ralf Dieckmann Sebastian Klingebiel Burkhard Moellenbeck Christoph Theil
author_facet	Thomas Ackmann Jan Schwarze Georg Gosheger Tom Schmidt-Braekling Kristian Nikolaus Schneider Ralf Dieckmann Sebastian Klingebiel Burkhard Moellenbeck Christoph Theil
author_sort	Thomas Ackmann
title	The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
title_short	The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
title_full	The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
title_fullStr	The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
title_full_unstemmed	The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
title_sort	change in plasma d-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/389b258bba9f4eaca52ce80c2b8c3afb
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The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection

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