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. 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. 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). D-dimer has limited performance for the diagnosis of PJI.

中文翻译：

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D-二聚体在假体周围关节感染诊断中的作用：系统评价和荟萃分析。

D-二聚体是一种与凝血有关的指标，最近已被用作诊断假体周围关节感染（PJI）的工具，但其可靠性尚不确定。该系统综述和荟萃分析的目的是探讨D-二聚体在关节置换术后诊断PJI中的准确性。我们系统地搜索了MEDLINE，EMBASE和Cochrane数据库，以获取有关D-二聚体诊断PJI的相关文献。QUADAS-2用于评估每个纳入研究的偏倚风险和临床适用性。我们使用双变量荟萃分析框架来汇总敏感性，特异性，正似然比（PLR），负似然比（NLR），诊断比值比（DOR）和SROC曲线下面积（AUC）。进行单变量荟萃回归和亚组分析以探索异质性的来源。我们纳入了8项合格研究。合并的诊断敏感性和特异性分别为0.82（95％CI，0.70-0.89）和0.70（95％CI，0.55-0.82）。合并的PLR，NLR和DOR分别为2.7（95％CI，1.7-4.4），0.26（95％CI，0.15-0.46）和10（95％CI，4-25）。AUC为0.83（95％CI，0.8-0.86）。对于PJI，血清D-二聚体的诊断准确度可能高于血浆D-二聚体（合并敏感性：0.88对0.67；合并特异性：0.76对0.61）。D-二聚体在诊断PJI方面的性能有限。15–0.46）和10（95％CI，4–25）。AUC为0.83（95％CI，0.8-0.86）。对于PJI，血清D-二聚体的诊断准确度可能高于血浆D-二聚体（合并敏感性：0.88对0.67；合并特异性：0.76对0.61）。D-二聚体在诊断PJI方面的性能有限。15–0.46）和10（95％CI，4–25）。AUC为0.83（95％CI，0.8-0.86）。对于PJI，血清D-二聚体的诊断准确度可能高于血浆D-二聚体（合并敏感性：0.88对0.67；合并特异性：0.76对0.61）。D-二聚体在诊断PJI方面的性能有限。