Subclinical Abnormal Coagulation in Periprosthetic Joint Infection: A Retrospective Cohort Study

Abstract Background：Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty and often indicate disastrous outcomes. However, the change of coagulation profile in PJI patients has not been explored up to now. Therefore, we performed a single-center retrospective cohort study to determine: 1) the coagulation profile in PJI patients 2) the diagnostic efficacy of coagulation profile for PJI diagnosis based on the MSIS criteria.Methods: Between 2016 January and 2018 December, a total of 371 patients receiving joint revisions were included in this cohort study. The corresponding medical records were scrutinized to establish the final diagnosis of PJI according to the 2014 MSIS criteria. The difference of coagulation profile between PJI and aseptic loosening patients was analyzed. Moreover, receiver operating characteristic curves were used to determine the proper sensitivity and specificity of coagulation makers.Results: The levels of APTT, D-dimer, plasma fibrinogen, INR and Platelet Count in PJI group were significantly higher than that in non-PJI group(P<0.05). The AUCs of plasma APTT, plasma D-dimer, plasma fibrinogen and platelet count for PJI diagnosis were0.625(95%CI:(0.543,0.706)),0.731(95%CI:(0.656,0.806)),0.831(95%CI:(0.771,0.890)) and 0.733(95%CI:(0.660,0.805)), respectively. Moreover, the coagulation profile was combined by logistic model and the corresponding AUC was0.865(95%CI:(0.812,0.918)).Conclusions: Despite relatively normal coagulation profile, PJI patients suffer from subclinical abnormal coagulation compared to non-PJI patients. The coagulation profile (APTT, INR, plasma fibrinogen, platelet count, D-dimer) in PJI patients is different from that in non-PJI patients significantly. And the coagulation profile can play a role in PJI diagnosis.