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DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE OF PINP AND Β-CROSSLAPS IN PEDIATRIC ACUTE HEMATOGENOUS OSTEOMYELITIS
Sh Yusupov1, O Kim1, J Atakulov1
11Department of Pediatric Surgery N1, Samarkand State Medical University, Uzbekistan.
Insights
Monitoring bone metabolism markers, including procollagen type 1 N-terminal propeptide (PINP) and beta-CrossLaps (β-CrossLaps), aids in managing acute hematogenous osteomyelitis (AHO) in children. The P/B index offers a sensitive tool for personalized treatment and improved outcomes.
Area of Science:
- Pediatric Orthopedics
- Biochemistry
- Bone Metabolism
Background:
- Bone metabolism in children shows distinct age-related patterns.
- Acute hematogenous osteomyelitis (AHO) requires monitoring of bone synthesis (PINP) and resorption (β-CrossLaps) markers.
- These markers assess disease phases and bone tissue's adaptive capacity.
Purpose of the Study:
- To analyze age-specific changes in bone metabolism markers (PINP and β-CrossLaps) in children with AHO.
- To evaluate the diagnostic utility of the P/B index and ROC analysis for assessing bone turnover.
- To propose a personalized monitoring algorithm for AHO management.
Main Methods:
- Analysis of PINP and β-CrossLaps levels in 200 children with AHO.
- Data collected at four time points: Day 1, Day 7, 2 months, and 6-8 months post-operatively.
- Statistical methods included ANOVA, P/B index calculation, and ROC analysis.
Main Results:
- PINP significantly increased in 1-4 year olds (11.9-fold) during repair.
- β-CrossLaps increased notably in adolescents (15-19 years, 10.5-fold).
- The P/B index showed high sensitivity (cut-offs >1.2 for osteogenesis, <0.8 for resorption), with combined ROC analysis yielding an AUC of 0.84.
Conclusions:
- The P/B index facilitates individualized AHO treatment and complication prevention.
- Integrating PINP, β-CrossLaps, and the P/B index enhances diagnostic accuracy and monitoring efficiency.
- A proposed personalized algorithm improves outcomes for pediatric AHO patients.
Introduction:
Bone metabolism in children exhibits pronounced age-related characteristics. In acute hematogenous osteomyelitis (AHO), monitoring the synthesis marker PINP and the resorption marker β-CrossLaps is particularly valuable, as it enables assessment of disease phases and the adaptive capacity of bone tissue.
Material And Method:
We analyzed PINP and β-CrossLaps levels in 200 children with AHO across age groups and at four time points: Day 1, Day 7, 2 months, and 6-8 months post-operatively. ANOVA, the P/B index, and ROC analysis were employed to assess sensitivity and specificity.
Results:
PINP exhibited a marked increase during the reparative phase in children aged 1-4 years (11.9-fold). β-CrossLaps rose predominantly in adolescents aged 15-19 years (10.5-fold). The P/B index proved the most sensitive, with diagnostic cut-offs of >1.2 for predominant osteogenesis and <0.8 for predominant resorption. ROC analysis of the combined model yielded an AUC of 0.84.
Conclusion:
The use of the P/B index enables individualized treatment, timely adjustment of mechanical loading and antibiotic therapy, and the prevention of complications. Integrating PINP, β-CrossLaps, and the P/B index into clinical practice improves diagnostic accuracy, enhances monitoring efficiency, and leads to better outcomes in children with acute osteomyelitis. A personalized monitoring algorithm covering all stages of the disease is proposed.
