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Objective <p>To investigate the associations of the preoperative D-dimer-to-albumin ratio (DAR) and prognostic nutritional index (PNI) with aseptic wound complications (AWC) and periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA), and to evaluate their within-sample discrimination for distinct postoperative adverse outcomes.</p> Methods <p>This single-center retrospective cohort study included patients who underwent primary unilateral TKA at the Affiliated Hospital of Qingdao University between April 2019 and January 2024. Patients with both AWC and PJI were classified in the PJI group only. Deep venous thrombosis was excluded preoperatively using lower-extremity color Doppler ultrasonography. DAR and PNI were calculated from laboratory tests obtained within 48&#xa0;h before surgery. AWC was assessed within 30 days after surgery, and PJI was assessed within 2 years according to the 2018 International Consensus Meeting criteria. Multivariable logistic regression, receiver operating characteristic (ROC) analysis with 95% confidence intervals (CIs), DeLong tests, bootstrap internal validation, calibration assessment, and sensitivity analyses were performed.</p> Results <p>A total of 1,197 patients were included, including 45 isolated AWC events and 35 PJI events. After adjustment for age, sex, body mass index, diabetes mellitus, and Charlson Comorbidity Index, preoperative PNI was independently associated with isolated AWC (odds ratio [OR], 0.613; 95% CI, 0.543–0.693; <i>P</i> &lt; 0.001), whereas preoperative DAR was not associated with isolated AWC (OR, 0.952; 95% CI, 0.852–1.064; <i>P</i> = 0.388). In contrast, DAR was independently associated with PJI (OR, 1.454; 95% CI, 1.328–1.592; <i>P</i> &lt; 0.001), whereas PNI was not significantly associated with PJI (OR, 0.915; 95% CI, 0.825–1.015; <i>P</i> = 0.094). PNI showed an AUC of 0.873 (95% CI, 0.792–0.955) for isolated AWC, and DAR showed an AUC of 0.920 (95% CI, 0.865–0.975) for PJI. Bootstrap optimism-corrected AUCs were 0.862 for the adjusted PNI-AWC model and 0.900 for the adjusted DAR-PJI model.</p> Conclusions <p>In this exploratory single-center retrospective cohort, preoperative PNI was more strongly associated with isolated AWC, whereas preoperative DAR was more strongly associated with PJI. Although both markers showed good apparent discrimination and high negative predictive values, the low event numbers, limited positive predictive values, imperfect calibration, and absence of external validation require cautious interpretation. Larger multicenter prospective studies are needed before these cutoffs can be applied as clinical decision thresholds.</p>

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Association of preoperative D-dimer-to-albumin ratio and prognostic nutritional index with aseptic wound complications and periprosthetic joint infection after primary total knee arthroplasty: a single-center retrospective cohort study

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  • 发表日期：

    2026年7月10日

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  • Zhi-Chao Han,
  • Xiao-Kai Liu,
  • Peng-Yuan Su,
  • Yuan-He Wang,
  • Shuo Yuan,
  • Bin-Hai Yu,
  • Zhen Liu,
  • Hong-Yu Wang,
  • Yan Wang,
  • Shao-Qi Tian

摘要

Objective

To investigate the associations of the preoperative D-dimer-to-albumin ratio (DAR) and prognostic nutritional index (PNI) with aseptic wound complications (AWC) and periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA), and to evaluate their within-sample discrimination for distinct postoperative adverse outcomes.

Methods

This single-center retrospective cohort study included patients who underwent primary unilateral TKA at the Affiliated Hospital of Qingdao University between April 2019 and January 2024. Patients with both AWC and PJI were classified in the PJI group only. Deep venous thrombosis was excluded preoperatively using lower-extremity color Doppler ultrasonography. DAR and PNI were calculated from laboratory tests obtained within 48 h before surgery. AWC was assessed within 30 days after surgery, and PJI was assessed within 2 years according to the 2018 International Consensus Meeting criteria. Multivariable logistic regression, receiver operating characteristic (ROC) analysis with 95% confidence intervals (CIs), DeLong tests, bootstrap internal validation, calibration assessment, and sensitivity analyses were performed.

Results

A total of 1,197 patients were included, including 45 isolated AWC events and 35 PJI events. After adjustment for age, sex, body mass index, diabetes mellitus, and Charlson Comorbidity Index, preoperative PNI was independently associated with isolated AWC (odds ratio [OR], 0.613; 95% CI, 0.543–0.693; P < 0.001), whereas preoperative DAR was not associated with isolated AWC (OR, 0.952; 95% CI, 0.852–1.064; P = 0.388). In contrast, DAR was independently associated with PJI (OR, 1.454; 95% CI, 1.328–1.592; P < 0.001), whereas PNI was not significantly associated with PJI (OR, 0.915; 95% CI, 0.825–1.015; P = 0.094). PNI showed an AUC of 0.873 (95% CI, 0.792–0.955) for isolated AWC, and DAR showed an AUC of 0.920 (95% CI, 0.865–0.975) for PJI. Bootstrap optimism-corrected AUCs were 0.862 for the adjusted PNI-AWC model and 0.900 for the adjusted DAR-PJI model.

Conclusions

In this exploratory single-center retrospective cohort, preoperative PNI was more strongly associated with isolated AWC, whereas preoperative DAR was more strongly associated with PJI. Although both markers showed good apparent discrimination and high negative predictive values, the low event numbers, limited positive predictive values, imperfect calibration, and absence of external validation require cautious interpretation. Larger multicenter prospective studies are needed before these cutoffs can be applied as clinical decision thresholds.