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Which inflammatory marker is more reliable in diagnosing acute septic arthritis in the pediatric population?
Serkan Bayram1, Fuat Bilgili1, Doğan Kıral1
1Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey.
Insights
The neutrophil to lymphocyte ratio (NLR) can aid in diagnosing septic arthritis (SA) in children, even with lower sensitivity than other markers. An NLR cut-off of 4.05 may help confirm SA diagnoses in clinical practice.
Area of Science:
- Pediatric Rheumatology
- Inflammatory Markers
- Septic Arthritis Diagnosis
Background:
- Septic arthritis (SA) diagnosis in children often relies on inflammatory markers.
- Investigating novel markers like neutrophil-to-lymphocyte ratio (NLR) is crucial for improved diagnostic accuracy.
Purpose of the Study:
- To evaluate the diagnostic utility of C-reactive protein (CRP), white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), NLR, and platelet-to-lymphocyte ratio (PLR) in pediatric SA.
- To compare the effectiveness of these inflammatory markers in the diagnosis of SA.
Main Methods:
- Retrospective analysis of medical records of 59 pediatric SA patients and 60 healthy controls.
- Comparison of hemogram parameters (WBC, neutrophils, lymphocytes, hemoglobin, platelets, CRP, ESR, NLR, PLR) and biochemical markers between groups.
Main Results:
- Significant differences were observed in all hemogram parameters between SA patients and controls.
- No significant differences were found in biochemical parameters between the groups.
Conclusions:
- While CRP, ESR, and WBC show higher sensitivity and specificity, NLR can be a valuable supplementary marker for SA diagnosis in children.
- An optimal diagnostic cut-off value of 4.05 for NLR was identified for confirming SA in clinical settings.
Background:
The present study aimed to investigate diagnostic values of C-reactive protein (CRP), white blood cell (WBC), erythrocyte sedimentation rate (ESR), neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio as possible indirect inflammatory markers in children with septic arthritis (SA) for diagnosis process.
Methods:
The medical records of pediatric patients with SA who underwent debridement surgery between February 2005 and November 2018 were obtained from the hospital records. A total of 59 children with SA and 60 age- and gender-matched healthy controls were enrolled in the study. Hemograms parameters including WBC count, neutrophil count, lymphocyte count, hemoglobin, platelet count, CRP, ESR, NLR, and platelet to lymphocyte ratio. Biochemical parameters including alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, glucose, and albumin were investigated and compared between both groups.
Results:
Fifty-nine patients, 30% female (n: 18) and 70% male (n: 41), who had received operations for SA were included in the study. The mean age of the patients was 7.1 (range 6 days to 15 years) years and mean follow up 56.6 (12-140) months. No significant differences were observed in any biochemical parameters between the groups. However, a significant difference was found between the septic arthritis and the control group in all hemogram parameters.
Conclusions:
Although the sensitivity and specificity of the NLR are lower than CRP, ESR, and WBC which are most commonly used inflammatory parameters in diagnosis process of septic arthritis, NLR may be useful in confirming the diagnosis in the clinical practise, with an optimum diagnostic cut-off value of 4.05.
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