From the Children's Minnesota Research Institute, Children's Minnesota.
Health Services Management, College of Continuing and Professional Studies, University of Minnesota, Minneapolis.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1220-e1226. doi: 10.1097/PEC.0000000000001978.
Septic arthritis (SA) is responsible for 20% of pediatric musculoskeletal infections (MSKI) and can have significant consequences. Early detection of SA is critical, and procalcitonin (PCT) has emerged as a promising biomarker. This study assessed the test performance of PCT and traditional biomarkers for suspected SA.
We conducted a prospective study at two pediatric emergency departments (ED). Data collected measured serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and PCT. Box and whisker plots were generated to compare the of the biomarkers by positive MSKI or a non-MSKI diagnosis. The diagnostic performance of biomarkers was examined using the area under the receiver operating characteristic curve (AUC), and optimal cut -points were identified using the Liu method.
Procalcitonin performed reasonably well for detection of MSKI (AUC, 0.72; confidence interval [95% CI], 0.59-0.84). However, CRP and ESR performed better (AUC, 0.88 and 0.78, respectively). White blood cell count was not predictive of MSKI. Patients with a PCT value >0.1 ng/mL, ESR values >19.5 mm/h, and a temperature higher than 99.0°F were more than twice as likely to have acute MSKI. A high CRP level was most predictive of acute MSKI, and patients with levels >2.38 mg/dL were 3.5 times more likely to have acute MSKI.
Procalcitonin is a potential biomarker for the clinical differential of MSKI in the pediatric ED. Additional research is warranted to establish the optimal diagnostic level for PCT, to increase sample size, and to examine any impact on cost.
脓毒性关节炎（SA）占儿科肌肉骨骼感染（MSKI）的 20%，可能产生重大后果。早期发现 SA 至关重要，降钙素原（PCT）已成为一种有前途的生物标志物。本研究评估了 PCT 和传统生物标志物对疑似 SA 的检测性能。
我们在两家儿科急诊部进行了一项前瞻性研究。收集的数据测量了血清 C 反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞（WBC）计数和 PCT 水平。通过阳性 MSKI 或非 MSKI 诊断，生成箱线图比较生物标志物的水平。使用接受者操作特征曲线（AUC）下的面积评估生物标志物的诊断性能，并使用 Liu 方法确定最佳截断值。
PCT 对 MSKI 的检测性能良好（AUC，0.72；95%置信区间[95%CI]，0.59-0.84）。然而，CRP 和 ESR 的表现更好（AUC 分别为 0.88 和 0.78）。白细胞计数对 MSKI 无预测作用。PCT 值>0.1ng/mL、ESR 值>19.5mm/h 和体温高于 99.0°F 的患者发生急性 MSKI 的可能性是两倍以上。高 CRP 水平最能预测急性 MSKI，水平>2.38mg/dL 的患者发生急性 MSKI 的可能性增加 3.5 倍。
降钙素原可能是儿科急诊部 MSKI 临床鉴别诊断的一种生物标志物。需要进一步研究来确定 PCT 的最佳诊断水平，增加样本量，并检查其对成本的任何影响。
