C-Reactive Protein Predicts Risk of Venous Thromboembolism in Pediatric Musculoskeletal Infection.

Autor:	Amaro E; School of Medicine., Marvi TK; School of Medicine., Posey SL; School of Medicine., Benvenuti MA; School of Medicine., An TJ; School of Medicine., Dale KM; Departments of Orthopaedics and Rehabilitation., Lovejoy SA; Departments of Orthopaedics and Rehabilitation.; Pediatrics., Martus JE; Departments of Orthopaedics and Rehabilitation.; Pediatrics., Johnson ME; Departments of Orthopaedics and Rehabilitation.; Pediatrics., Mencio GA; Departments of Orthopaedics and Rehabilitation.; Pediatrics., Moore-Lotridge SN; Departments of Orthopaedics and Rehabilitation.; Department of Pharmacology, Vanderbilt University, Nashville, TN., Thomsen IP; Pediatrics.; Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN., Schoenecker JG; Departments of Orthopaedics and Rehabilitation.; Pediatrics.; Department of Pharmacology, Vanderbilt University, Nashville, TN.; Pathology Microbiology and Immunology.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2019 Jan; Vol. 39 (1), pp. e62-e67.
DOI:	10.1097/BPO.0000000000001256
Abstrakt:	Background: The rate of venous thromboembolism in children with musculoskeletal infections (MSKIs) is markedly elevated compared with hospitalized children in general. Predictive biomarkers to identify high-risk patients are needed to prevent the significant morbidity and rare mortality associated with thrombotic complications. We hypothesize that overactivation of the acute phase response is associated with the development of pathologic thrombi and we aim to determine whether elevations in C-reactive protein (CRP) are associated with increased rates of thrombosis in pediatric patients with MSKI. Methods: A retrospective cohort study measuring CRP in pediatric MSKI patients with or without thrombotic complications. Results: The magnitude and duration of elevation in CRP values correlated with the severity of infection and the development of pathologic thrombosis. In multivariable logistic regression, every 20 mg/L increase in peak CRP was associated with a 29% increased risk of thrombosis (P<0.001). Peak and total CRP were strong predictors of thrombosis with area under the receiver-operator curves of 0.90 and 0.92, respectively. Conclusions: Future prospective studies are warranted to further define the discriminatory power of CRP in predicting infection-provoked thrombosis. Pharmacologic prophylaxis and increased surveillance should be strongly considered in patients with MSKI, particularly those with disseminated disease and marked elevation of CRP. Level of Evidence: Level III.
Databáze:	MEDLINE
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