Kahane Caroline G, Nigrovic Lise E, Kharbanda Anupam B, Neville Desiree, Thompson Amy D, Balamuth Fran, Chapman Laura, Levas Michael N, Branda John A, Kellogg Mark D, Monuteaux Michael C, Lyons Todd W
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota.
Pediatrics. 2023 Aug 1;152(2). doi: 10.1542/peds.2023-061329.
Bacterial musculoskeletal infections (MSKIs) are challenging to diagnose because of the clinical overlap with other conditions, including Lyme arthritis. We evaluated the performance of blood biomarkers for the diagnosis of MSKIs in Lyme disease-endemic regions.
We conducted a secondary analysis of a prospective cohort study of children 1 to 21 years old with monoarthritis presenting to 1 of 8 Pedi Lyme Net emergency departments for evaluation of potential Lyme disease. Our primary outcome was an MSKI, which was defined as septic arthritis, osteomyelitis or pyomyositis. We compared the diagnostic accuracy of routinely available biomarkers (absolute neutrophil count, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin) to white blood cells for the identification of an MSKI using the area under the receiver operating characteristic curve (AUC).
We identified 1423 children with monoarthritis, of which 82 (5.8%) had an MSKI, 405 (28.5%) Lyme arthritis, and 936 (65.8%) other inflammatory arthritis. When compared with white blood cell count (AUC, 0.63; 95% confidence interval [CI], 0.55-0.71), C-reactive protein (0.84; 95% CI, 0.80-0.89; P < .05), procalcitonin (0.82; 95% CI, 0.77-0.88; P < .05), and erythrocyte sedimentation rate (0.77; 95% CI, 0.71-0.82; P < .05) had higher AUCs, whereas absolute neutrophil count (0.67; 95% CI, 0.61-0.74; P < .11) had a similar AUC.
Commonly available biomarkers can assist in the initial approach to a potential MSKI in a child. However, no single biomarker has high enough accuracy to be used in isolation, especially in Lyme disease-endemic areas.
由于细菌引起的肌肉骨骼感染（MSKIs）在临床上与包括莱姆关节炎在内的其他病症存在重叠，因此其诊断具有挑战性。我们评估了血液生物标志物在莱姆病流行地区诊断MSKIs的性能。
我们对一项前瞻性队列研究进行了二次分析，该研究对象为1至21岁患单关节炎的儿童，他们前往8个小儿莱姆病网络急诊科之一，以评估潜在的莱姆病。我们的主要结局是MSKI，其定义为化脓性关节炎、骨髓炎或脓性肌炎。我们使用受试者操作特征曲线下面积（AUC），将常规可用生物标志物（绝对中性粒细胞计数、C反应蛋白、红细胞沉降率和降钙素原）与白细胞用于识别MSKI的诊断准确性进行了比较。
我们确定了1423名单关节炎儿童，其中82名（5.8%）患有MSKI，405名（28.5%）患有莱姆关节炎，936名（65.8%）患有其他炎性关节炎。与白细胞计数（AUC，0.63；95%置信区间[CI]，0.55 - 0.71）相比，C反应蛋白（0.84；95%CI，0.80 - 0.89；P < 0.05）、降钙素原（0.82；95%CI，0.77 - 0.88；P < 0.05）和红细胞沉降率（0.77；95%CI，0.71 - 0.82；P < 0.05）具有更高的AUC，而绝对中性粒细胞计数（0.67；95%CI，0.61 - 0.74；P < 0.11）的AUC相似。
常用生物标志物可有助于对儿童潜在的MSKI进行初步评估。然而，没有单一生物标志物具有足够高的准确性可单独使用，尤其是在莱姆病流行地区。
