Is Fibrinogen a Reliable Biomarker in the Diagnosis of Peri-Prosthetic Joint Infection? A Systematic Review and Meta-Analysis

Background: In recent years, several studies have identified closed correlations between the coagulation cascade and inflammatory mechanisms in infective diseases. Fibrinogen (PF) is emerging as promising biomarker for the diagnosis of peri-prosthetic joint infection (PJI). This study aims to investigate the diagnostic value of PF in diagnosing PJI and to explore potential causes influencing the diagnostic value of PF. Materials and Methods: PubMed, Embase, and Cochrane Library were searched regarding the role of fibrinogen as a biomarker in the diagnosis of PJI. Studies in English were included in the meta-analysis if they determined the diagnostic value of fibrinogen for PJI detection after hip or knee arthroplasty, applying the recognized diagnostic criteria for PJI. A quality evaluation of the studies included was performed. The pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUROC) were obtained using the statistical software STATA, version 17 (StataCorp, College Station, TX). Results: Ten studies (9 retrospective) were included in the study. Low publication bias was detected, but with high heterogeneity among them. Plasma fibrinogen showed a good diagnostic accuracy and clinical utility in PJI (sensitivity, 0.81 [95% confidence interval {CI}, 0.75-0.86]; specificity, 0.82 [95% CI, 0.76-0.86]; AUROC, 0.88 [95% CI, 0.85-0.91]; DOR, 19 [95% CI, 14-26]). Conclusions: The attempt to find an "ideal" biomarker is crucial to improve the sensitivity and specificity of the current diagnostic algorithms for PJI. The analysis performed in the current study indicates that plasma fibrinogen test is a valid biomarker for PJI diagnosis.