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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

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 unde...

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Autores principales: Ackmann, Thomas, Schwarze, Jan, Gosheger, Georg, Schmidt-Braekling, Tom, Schneider, Kristian Nikolaus, Dieckmann, Ralf, Klingebiel, Sebastian, Moellenbeck, Burkhard, Theil, Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016946/
https://www.ncbi.nlm.nih.gov/pubmed/33795812
http://dx.doi.org/10.1038/s41598-021-86890-z
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author Ackmann, Thomas
Schwarze, Jan
Gosheger, Georg
Schmidt-Braekling, Tom
Schneider, Kristian Nikolaus
Dieckmann, Ralf
Klingebiel, Sebastian
Moellenbeck, Burkhard
Theil, Christoph
author_facet Ackmann, Thomas
Schwarze, Jan
Gosheger, Georg
Schmidt-Braekling, Tom
Schneider, Kristian Nikolaus
Dieckmann, Ralf
Klingebiel, Sebastian
Moellenbeck, Burkhard
Theil, Christoph
author_sort Ackmann, Thomas
collection PubMed
description 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.
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spelling pubmed-80169462021-04-07 The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection Ackmann, Thomas Schwarze, Jan Gosheger, Georg Schmidt-Braekling, Tom Schneider, Kristian Nikolaus Dieckmann, Ralf Klingebiel, Sebastian Moellenbeck, Burkhard Theil, Christoph Sci Rep Article 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. Nature Publishing Group UK 2021-04-01 /pmc/articles/PMC8016946/ /pubmed/33795812 http://dx.doi.org/10.1038/s41598-021-86890-z Text en © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Ackmann, Thomas
Schwarze, Jan
Gosheger, Georg
Schmidt-Braekling, Tom
Schneider, Kristian Nikolaus
Dieckmann, Ralf
Klingebiel, Sebastian
Moellenbeck, Burkhard
Theil, Christoph
The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
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_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_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_sort change in plasma d-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016946/
https://www.ncbi.nlm.nih.gov/pubmed/33795812
http://dx.doi.org/10.1038/s41598-021-86890-z
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