Abstract Number: PB0744
Meeting: ISTH 2022 Congress
Background: Bacterial infection activates coagulation through immunothrombosis. Neutrophils may be involved in periprosthetic joint infections (PJI) by releasing neutrophil extracellular traps (NETs) present in the bacterial biofilm. As PJI diagnosis is often uncertain due to lack of compliance with some criteria, we previously obtained a model to estimate the pre-surgical PJI risk using markers of NETs and thrombin generation test (TGT).
Aims: To improve the performance of our model including additional coagulation markers and to validate its diagnostic capacity of PJI.
Methods: We obtained citrated plasma, in the preoperative period of prosthetic surgery, from 111 patients prospectively recruited. PJI was confirmed in 50 of these patients, 46 had no infection, while PJI was uncertain in 15 patients, which is relatively frequent as above mentioned. Besides NETs markers (cell-free DNA, nucleosomes, myeloperoxidase, calprotectin, elastase) and the TGT, we analyzed PT, APTT, TT, fibrinogen, D-dimer, procalcitonin, α-defensins and IL-6. We performed a multivariable logistic regression model penalized with elastic net using R (v3.5.0).
Results: cfDNA, calprotectin, elastase, starttail of TGT, fibrinogen α-defensins and IL-6 were significantly increased in PJI patients compared with patients undergoing prosthetic surgery due to non-septic causes. The new coagulation markers studied did not improve our predictive model of PJI containing markers of NETs (cfDNA and calprotectin) and the starttail of TGT; thus, we validated it achieving an AUC=0.77 (95%CI [0.58, 1]; P=0.019).
Conclusion(s): An activation of coagulation and immunothrombosis seems to occur in patients with PJI. Markers of NETs and TGT seem to have diagnostic utility of PJI before surgery. Our model could reinforce current clinical criteria to reduce the number of uncertain diagnoses and thus be able to make an early and effective diagnosis and treatment to minimize side effects of the PJI such as tissue damage, bone degradation and replacement surgery. ISCIII-FEDER (PI17/00495, PI20/00075, FI21/00171), GVA (ACIF/2017/138), Zimmer Biomet and SETH.
To cite this abstract in AMA style:Oto J, Herranz R, Fernández-Pardo A, Fuertes M, Plana E, Cañada A, Cana F, De La Calva C, Angulo M, Arguelles F, Baeza J, Baixauli I, Baixauli F, Amaya J, Medina P. Coagulation markers improve the diagnosis of periprosthetic joint infection: involvement of immunothrombosis [abstract]. https://abstracts.isth.org/abstract/coagulation-markers-improve-the-diagnosis-of-periprosthetic-joint-infection-involvement-of-immunothrombosis/. Accessed September 26, 2022.
« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/coagulation-markers-improve-the-diagnosis-of-periprosthetic-joint-infection-involvement-of-immunothrombosis/