Risk factor analysis for deep vein thrombosis in children with acute hematogenous osteomyelitis

This study aims to explore the correlation between Acute Hematogenous Osteomyelitis (AHO) and Deep Venous Thrombosis (DVT) in children. It seeks to identify independent risk factors for DVT secondary to AHO, enhance understanding of the disease, and establish a predictive model to guide clinical practice.

A retrospective analysis of clinical data from AHO patients treated at our hospital (January 2017 to December 2023) was conducted. Patients were divided into thrombosis and non-thrombosis groups based on DVT occurrence. Univariate analysis used independent samples t-tests, Mann-Whitney U tests, and chi-square tests to screen DVT-associated variables (P < 0.1). Significant variables were included in a binary logistic regression model to identify independent risk factors for DVT secondary to AHO. Model fit was assessed using the Hosmer-Lemeshow test, and Cox-Snell R² was calculated through linear regression of P-values with the dependent variable. ROC curves were plotted, and AUC was recorded to evaluate model validity and reliability.

Univariate analysis revealed significant correlations between DVT and several factors, including age, peak levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and D-dimer. Additionally, the time for CRP to normalize, concurrent pneumonia, intensive care use, the severity of osteomyelitis (Lawson score), and femoral involvement in osteomyelitis were also significantly associated with DVT (P < 0.05). Binary logistic regression identified age (OR = 1.248), D-dimer (OR = 1.600), and concurrent pneumonia (OR = 4.921) as significantly positively associated with secondary DVT (P < 0.05). The model demonstrated good goodness-of-fit (P > 0.05), accurately explained the data (R² = 0.449, Cox-Snell R² = 0.413), and had strong predictive performance (AUC = 0.895).

Age, peak levels of CRP/ESR/PCT/D-dimer, osteomyelitis severity (Lawson score), femoral involvement in osteomyelitis, and concurrent pneumonia were significantly associated with secondary deep vein thrombosis (DVT) in pediatric acute hematogenous osteomyelitis (AHO). Among these, age, peak D-dimer levels, and concurrent pneumonia were identified as independent risk factors for DVT in children with AHO. The current predictive model demonstrated good performance in this cohort, providing early warning for potential DVT risk in pediatric AHO patients. However, multicenter studies are needed to further validate its generalizability. Pediatricians may use this model to assess the necessity of DVT screening, reduce missed diagnoses, and initiate timely antithrombotic therapy to prevent adverse outcomes.