Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty
<b>Background/Objectives:</b> There is a lack of reliable biomarkers for diagnosis of infection eradication prior to second-stage reimplantation in two-stage exchange arthroplasty for periprosthetic joint infections (PJIs). The aim of this study was to assess the diagnostic accuracy of r...
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MDPI AG
2024-03-01
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| Series: | Journal of Clinical Medicine |
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| author | Andreas G. Tsantes Dimitrios V. Papadopoulos Stavros Goumenos Ioannis G. Trikoupis Konstantina A. Tsante Christos Koutserimpas Panagiotis Koulouvaris Vasileios Petrakis Aristeidis G. Vaiopoulos Daniele Piovani Georgios K. Nikolopoulos Andreas F. Mavrogenis Panayiotis J. Papagelopoulos Stefanos Bonovas Argirios E. Tsantes |
| author_facet | Andreas G. Tsantes Dimitrios V. Papadopoulos Stavros Goumenos Ioannis G. Trikoupis Konstantina A. Tsante Christos Koutserimpas Panagiotis Koulouvaris Vasileios Petrakis Aristeidis G. Vaiopoulos Daniele Piovani Georgios K. Nikolopoulos Andreas F. Mavrogenis Panayiotis J. Papagelopoulos Stefanos Bonovas Argirios E. Tsantes |
| author_sort | Andreas G. Tsantes |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> There is a lack of reliable biomarkers for diagnosis of infection eradication prior to second-stage reimplantation in two-stage exchange arthroplasty for periprosthetic joint infections (PJIs). The aim of this study was to assess the diagnostic accuracy of rotational thromboelastometry (ROTEM) for persistent infection in two-stage exchange arthroplasties. <b>Methods:</b> A pilot, retrospective analysis was performed including 70 patients who underwent a two-stage exchange arthroplasty for PJI. They were categorized as patients without (<i>n</i> = 64) or patients with persistent infection (<i>n</i> = 6) prior to reimplantation. Definition of persistent infection prior to reimplantation was based on the 2018 ICM criteria. Conventional coagulation biomarkers and ROTEM parameters were compared between groups. <b>Results:</b> Higher FIBTEM MCF values were associated with persistent infection (odds ratio [OR], 1.30, 95% confidence interval [CI], 1.04–1.63; <i>p</i> = 0.020), and FIBTEM MCF had the highest diagnostic accuracy for persistent infection prior to second-stage reimplantation (AUC, 0.907; 95% CI, 0.812–1.000). A cut-off value ≥ 18 mm for FIBTEM MCF was found to have 100.0% sensitivity and 73.4% specificity for diagnosing persistent infection prior to second-stage reimplantation. Moreover, the diagnostic accuracy of FIBTEM MCF was higher than that of fibrinogen levels (<i>p</i> = 0.036) and D-dimer (<i>p</i> = 0.006). <b>Conclusions:</b> Our findings indicate that ROTEM parameters have the potential to identify persistent infections before reimplantation in two-stage exchange arthroplasties for PJI. Such coagulation biomarkers could provide guidance regarding the optimal timing for reimplantation. Further studies in larger populations are warranted to validate the diagnostic accuracy of ROTEM parameters for persistent PJI. |
| first_indexed | 2024-04-24T10:40:58Z |
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| language | English |
| last_indexed | 2024-04-24T10:40:58Z |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-30629911db2c492284a050949122b9832024-04-12T13:21:06ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01137194210.3390/jcm13071942Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange ArthroplastyAndreas G. Tsantes0Dimitrios V. Papadopoulos1Stavros Goumenos2Ioannis G. Trikoupis3Konstantina A. Tsante4Christos Koutserimpas5Panagiotis Koulouvaris6Vasileios Petrakis7Aristeidis G. Vaiopoulos8Daniele Piovani9Georgios K. Nikolopoulos10Andreas F. Mavrogenis11Panayiotis J. Papagelopoulos12Stefanos Bonovas13Argirios E. Tsantes14Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceFirst Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceFirst Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceLaboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceOrthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, 69004 Lyon, FranceFirst Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece2nd University Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68132 Alexandroupolis, GreeceLaboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceDepartment of Biomedical Sciences, Humanitas University, 20072 Milan, ItalyLaboratory of Medical Statistics, Epidemiology and Public Health, Medical School, University of Cyprus, Nicosia 1678, CyprusFirst Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceFirst Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceDepartment of Biomedical Sciences, Humanitas University, 20072 Milan, ItalyLaboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece<b>Background/Objectives:</b> There is a lack of reliable biomarkers for diagnosis of infection eradication prior to second-stage reimplantation in two-stage exchange arthroplasty for periprosthetic joint infections (PJIs). The aim of this study was to assess the diagnostic accuracy of rotational thromboelastometry (ROTEM) for persistent infection in two-stage exchange arthroplasties. <b>Methods:</b> A pilot, retrospective analysis was performed including 70 patients who underwent a two-stage exchange arthroplasty for PJI. They were categorized as patients without (<i>n</i> = 64) or patients with persistent infection (<i>n</i> = 6) prior to reimplantation. Definition of persistent infection prior to reimplantation was based on the 2018 ICM criteria. Conventional coagulation biomarkers and ROTEM parameters were compared between groups. <b>Results:</b> Higher FIBTEM MCF values were associated with persistent infection (odds ratio [OR], 1.30, 95% confidence interval [CI], 1.04–1.63; <i>p</i> = 0.020), and FIBTEM MCF had the highest diagnostic accuracy for persistent infection prior to second-stage reimplantation (AUC, 0.907; 95% CI, 0.812–1.000). A cut-off value ≥ 18 mm for FIBTEM MCF was found to have 100.0% sensitivity and 73.4% specificity for diagnosing persistent infection prior to second-stage reimplantation. Moreover, the diagnostic accuracy of FIBTEM MCF was higher than that of fibrinogen levels (<i>p</i> = 0.036) and D-dimer (<i>p</i> = 0.006). <b>Conclusions:</b> Our findings indicate that ROTEM parameters have the potential to identify persistent infections before reimplantation in two-stage exchange arthroplasties for PJI. Such coagulation biomarkers could provide guidance regarding the optimal timing for reimplantation. Further studies in larger populations are warranted to validate the diagnostic accuracy of ROTEM parameters for persistent PJI.https://www.mdpi.com/2077-0383/13/7/1942periprosthetic joint infectionspersistent infectiontwo-stage exchange arthroplastydiagnosisrotational thromboelastometry |
| spellingShingle | Andreas G. Tsantes Dimitrios V. Papadopoulos Stavros Goumenos Ioannis G. Trikoupis Konstantina A. Tsante Christos Koutserimpas Panagiotis Koulouvaris Vasileios Petrakis Aristeidis G. Vaiopoulos Daniele Piovani Georgios K. Nikolopoulos Andreas F. Mavrogenis Panayiotis J. Papagelopoulos Stefanos Bonovas Argirios E. Tsantes Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty Journal of Clinical Medicine periprosthetic joint infections persistent infection two-stage exchange arthroplasty diagnosis rotational thromboelastometry |
| title | Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty |
| title_full | Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty |
| title_fullStr | Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty |
| title_full_unstemmed | Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty |
| title_short | Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty |
| title_sort | rotational thromboelastometry as a diagnostic tool for persistent infection in two stage exchange arthroplasty |
| topic | periprosthetic joint infections persistent infection two-stage exchange arthroplasty diagnosis rotational thromboelastometry |
| url | https://www.mdpi.com/2077-0383/13/7/1942 |
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