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Abstract：
Background/Objectives: 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. Methods: A pilot, retrospective analysis was performed including 70 patients who underwent a two-stage exchange arthroplasty for PJI. They were categorized as patients without (n = 64) or patients with persistent infection (n = 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. Results: Higher FIBTEM MCF values were associated with persistent infection (odds ratio [OR], 1.30, 95% confidence interval [CI], 1.04-1.63; p = 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 (p = 0.036) and D-dimer (p = 0.006). Conclusions: 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.
摘要：
背景/目标：缺乏可靠的生物标志物来诊断在二阶段置换关节假体周围感染（PJIs）的第二阶段再植入之前的感染根除。这项研究的目的是评估旋转血栓弹性测定法（ROTEM）对两阶段交换性关节置换术中持续感染的诊断准确性。方法：飞行员，我们进行了回顾性分析,包括70例接受了2期PJI置换的患者.在重新植入之前，他们被归类为没有（n=64）或持续感染（n=6）的患者。再植入前持续性感染的定义基于2018年ICM标准。组间比较常规凝血生物标志物和ROTEM参数。结果：较高的FIBTEMMCF值与持续感染相关(比值比[OR]，1.30，95%置信区间[CI]，1.04-1.63；p=0.020），FIBTEMMCF在第二阶段再植入前对持续性感染的诊断准确率最高(AUC，0.907；95%CI，0.812-1.000）。发现FIBTEMMCF的临界值≥18mm对于在第二阶段再植入之前诊断持续性感染具有100.0％的敏感性和73.4％的特异性。此外，FIBTEMMCF的诊断准确率高于纤维蛋白原水平(p=0.036)和D-二聚体(p=0.006).结论：我们的发现表明，ROTEM参数有可能在PJI的两阶段交换关节置换术中重新植入之前识别持续性感染。这种凝血生物标志物可以提供关于再植入的最佳时机的指导。需要在更大的人群中进行进一步的研究，以验证ROTEM参数对持久性PJI的诊断准确性。
