Correlation between Progress of D-Dimer Following Total Joint Arthroplasty and Early Postoperative Wound and Joint Infection

Yıl 2021, Cilt: 8 Sayı: 2, 91 - 96, 31.08.2021

Emre Gültaç , Fatih Can , Cem Yalın Kılınç , Hıdır Tanyıldızı , Ahmet Acan , Nevres Aydoğan

Öz

Postoperative infection after joint arthroplasty is a bad complication with incontrovertible incidence and early detection is essential. The purpose of this retrospective study was to evaluate postoperative change of D-Dimer level after joint arthroplasty along with other proinflammatory mediators and to determine the correlation between progress of D-Dimer and early postoperative infection. From January 2017 until March 2018, a retrospective evaluation of 121 patients operated for elective primary total hip arthroplasty (49 patients) or total knee arthroplasty (72 patients) was conducted. CRP, INR, troponin and D-Dimer level were noted on the preoperative day 1, postoperative days 1, 3, 7, 14 and perioperative changes compared. All patients were followed up for infection. 121 patients included in the study. The variability of postoperative CRP and INR values was similar. D-Dimer showed a more rapid rise and fall than CRP in early postoperative period. Early wound infections were detected in 24 patients (19.8%) and 70% of the patients with wound infection had early postoperative D-Dimer increase and also a significant relationship was found between the patients with wound infection in the early period and the increase in CRP level (p<0.05). The fluctuation and instability of D-Dimer values during the postoperative follow-up period suggests that it may be unlikely to be used as a strong indicator of infection. If only the D-Dimer levels combined with other inflammatory mediators like CRP etc. then it might be effective in early detection of wound infection after joint arthroplasty.

Anahtar Kelimeler

Arthroplasty, CRP, D-Dimer, Periprosthetic Wound Infection

Destekleyen Kurum

none

Proje Numarası

none

Teşekkür

none

Total Eklem Artroplastisini Takiben D-Dimer'ın Progresyonu ile Erken Postoperative Yara ve Eklem Enfeksiyonu Arasındaki İlişki

Öz

Eklem artroplastisi sonrası postoperative enfeksiyon, azımsanamayacak derecede insidansı olan kötü bir komplikasyondur ve erken tespiti önemlidir. Bu retrospektif çalışmanın amacı, eklem artroplastisi sonrası postoperatif D-Dimer düzeyindeki değişimi diğer proinflamatuar mediatörlerle birlikte değerlendirmek ve D-Dimer progresyonu ile erken postoperative yara enfeksiyonu arasındaki ilişkiyi belirlemektir. Ocak 2017'den Mart 2018'e kadar, elektif primer total kalça artroplastisi (49 hasta) veya total dizartroplastisi (72 hasta) ameliyatı yapılan 121 hastanın retrospektif bir değerlendirmesi yapıldı. CRP, INR, troponin ve D-Dimer düzeyleri preoperatif 1. gün, postoperatif 1., 3., 7., 14. Günlerde kaydedildi ve perioperative değişiklikler karşılaştırıldı. Tüm hastalar enfeksiyon açısından takip edildi. Çalışmaya toplam 121 hasta (% 76.9 kadın, % 23.1 erkek) dahil edildi. Postoperatif CRP ve INR değerlerinin değişkenliği benzerdi. D-Dimer erken postoperative dönemde CRP'den daha hızlı yükselme ve düşüş gösterdi. Postoperatif dönemde artan akut faz reaktanları olan CRP ve D-Dimer'ın eş zamanlı yükselmesinin ardından, enfeksiyondan bağımsız olarak süreç içinde CRP'nin normal değerlerine dönerken D-Dimer'ın tekrar pik yaptığı görüldü. Yirmi dört hastada (%19.8) erken yara enfeksiyonu tespit edildi ve yara enfeksiyonu olan hastaların %70'inde erken postoperatif D-Dimer artışı görüldü ve ayrıca erken dönemde yara enfeksiyonu olan hastalardaki CRP düzeyindeki artış ile D-Dimer yükselişi arasında anlamlı bir ilişki bulundu (p<0.05). Postoperatif takip döneminde D-Dimer değerlerinin dalgalanması ve dengesizliği, güçlü bir enfeksiyon göstergesi olarak kullanılmasının olası olmadığını düşündürmektedir. Sadece D-Dimer seviyeleri diğer enflamatuar aracılarla kombine edilerek değerlendirilirse, eklem artroplastisi sonrası enfeksiyonunun erken tespitinde etkili olabilir.

Anahtar Kelimeler

Artroplasti, CRP, D-Dimer, Periprostetik Yara nfeksiyonu

Proje Numarası

none

Kaynakça

• 1. Gaffney PJ, Edgell T, Creighton-Kempsford LJ, et al. Fibrin degradation product (FnDP) assays: analysis of standardization issues and target antigens in plasma. Br J Haematol. 1995; 90: 187–94.
• 2. Lip GYH, Lowe GDO. Fibrin D-dimer: a usefulclinical marker of thrombogenesis? Clin Sci. 1995; 89: 205–14.
• 3. Dunn I, Hui A, Triffitt P, et al. Plasma D-dimer as a marker of postoperative deep vein thrombosis. Thromb Haemost. 1994; 72: 663–5.
• 4. Shiota N, Sato T, Nishida K, et al. Changes in LPIA D-dimer levels after total hip or knee arthroplasty relevant to deep vein thrombosis by bilateral ascending venography. J Orthop Sci. 2002; 7: 444–50.
• 5. Yoo MC, Cho YJ, Ghanem E. Deep vein thrombosis after total hiparthroplasty in Korean patients and D-dimer as a screening tool. Arch Orthop Trauma Surg. 2009;129(7): 887-94.
• 6. Becattini C, Lignani A, Masotti L. D-dimer for risk stratification in patients with acute pulmonary embolism. J Thromb Thrombolysis. 2012; 33(1): 48-57.
• 7. Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem. 2004; 279:48487.
• 8. Marnell L, Mold C, DuClos TW. C-reactive protein: ligands, receptors and role in inflammation. Clin Immunol. 2005; 117:104.
• 9. Ballou SP, Lozanski G. Induction of inflammatory cytokine release from cultured human monocytes by C-reactive protein. Cytokine. 1992; 4:361.
• 10. Cermak J, Key NS, Bach RR, et al. C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood. 1993; 82:513.
• 11. Jones SA, Novick D, Horiuchi S, et al. C-reactive protein: a physiological activator of interleukin 6 receptor shedding. J Exp Med. 1999; 189:599.
• 12. Griselli M, Herbert J, Hutchinson WL, et al. C-reactive protein and complementare important mediators of tissue damage in acute myocardial infarction. J Exp Med. 1999; 190:1733.
• 13. Rudasill SE, Liu J, Kamath AF. Revisitingthe International Normalized Ratio (INR) Threshold for Complications in Primary Total Knee Arthroplasty: An Analysis of 21,239 Cases. J Bone Joint Surg Am. 2019;101(6):514-22.
• 14. Abdel-Aziz MI, Ali MA, Hassan AK, et al. Factors influencing warfarin response in hospitalized patients. Saudi Pharm J. 2015;23(6):642-9.
• 15. Kerr G, Ray G, Wu O, et al. Elevated troponin after stroke: a systematic review. Cerebrovasc Dis. 2009;28(3):220-6.
• 16. Amman P, Maggiorini M, Bertel O, et al. Troponin as a risk factor for mortality in critically ill patients with acute coronary syndrome. J Am Coll Cardiol. 2003;41(11):2004–9.
• 17. Gando S. Role of fibrinolys is in sepsis. Semin Thromb Hemost. 2013;39(4): 392-9.
• 18. Michelin E, Snijders D, Conte S, et al. Procoagulant activity in children with community acquired pneumonia, pleural effusion and empyema. Pediatr Pulmonol. 2008;43(5):472-5.
• 19. Rodelo JR, De la Rosa G, Valencia ML, et al. D-dimer is a significant prognostic factor in patients with suspected infection and sepsis. Am J Emerg Med. 2012;30(9):1991-9.
• 20. Lee YS, Lee YK, Han SB, et al. Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg Res. 2018;13(1):36.
• 21. Shahi A, Kheir MM, Tarabichi M, et al. Serum D-Dimer test is promising for the diagnosis of periprosthetic joint ınfection and timing of reimplantation. J Bone Joint Surg Am. 2017;99(17):1419-27.
• 22. Hu Q, Fu Y, Tang L. Serum D-dimer as a diagnostic index of PJI and retrospective analysis of etiology in patients with PJI. Clin Chim Acta. 2020;506:67-71.
• 23. Pannu TS, Villa JM, Patel PD, et al. TheUtility of Serum d-Dimer for the Diagnosis of Periprosthetic Joint Infection in Revision Total Hip and Knee Arthroplasty. J Arthroplasty. 2020;35(6):1692-5.
• 24. Gehrke T, Parvizi J. Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection. J Arthroplasty. 2014;29(2):1-130.
• 25. Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992;(275):237-42.
• 26. Bilgen O, Atici T, Durak K, et al. C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res. 2001;29(1):7-12.
• 27. Zhang, J, Zhao, K., Li, J. et al. Age over 65 years and high levels of C-reactive protein are associated with the risk of preoperative deep vein thrombosis following closed distal femur fractures: a prospective cohort study. J Orthop Surg Res. 2020; 15: 559.
• 28. Tang Y, Fung E, Xu A, Lan HY. C-reactive protein and ageing. Clin Exp Pharmacol Physiol. 2017;44(1):9-14.