Researchers have identified a key biomarker to predict patients at high-risk for developing venous thromboembolism (VTE) in pediatric musculoskeletal infections (MSKIs), a potentially significant step toward preventing morbidity and mortality from a dangerous complication.
A study published in the Journal of Pediatric Orthopaedics found that the levels of C-reactive protein (CRP) during the body’s acute phase response (APR) to injury were strongly correlated with risk of VTE.
This shows that if CRP levels can be tested during APR, physicians can better risk-stratify patients and preventative measures can be taken sooner to prevent VTE from developing.
If CRP levels can be tested during APR, physicians can better risk-stratify patients and preventative measures can be taken sooner to prevent VTE.
Previous studies have shown pediatric patients with MSKIs are at significantly higher risk of VTE than the general population, underscoring the importance of identifying those at risk as early as possible.
“Unfortunately, there are no measures that permit a treating physician to determine which child with musculoskeletal infection is at risk for thrombosis and therefore treat prophylactically,” Jonathan Schoenecker M.D., assistant professor in the Division of Pediatric Orthopaedics at Vanderbilt University Medical Center, said about why the study was conducted. “In this study, we determined that a measure of inflammation, C-reactive protein, is associated with the incidence of thrombosis.”
Pharmacologic Prophylaxis Could Provide Strong Benefit for MSKI Patients
Vanderbilt researchers did a retrospective review of patients age 0 to 18 who had an orthopaedic consult for MSKI from 2008 to 2013 for the study. They collected CRP values from the time of admission until CRP normalization or discharge.
CRP was used as the measure of APR as it is a well-known pro-inflammatory reactant and pro-coagulant during APR, the body’s hormonal response to injury to stop bleeding, infection, and tissue dysfunction.
Overall, peak CRP elevation was found to have a strong link to the risk of VTE, and the correlation existed independent of patient age. A 20 mg/L increase in peak CRP showed a 28 percent increased risk of VTE, with the risk continually rising as the mg/L increased.
Researchers concluded pharmacologic prophylaxis should be considered for MSKI patients going through APR and that evaluative studies are needed. The potential benefit for MSKI patients was compared to what has occurred since the use of prophylaxis was introduced in adult total joint arthroplasty, where VTE occurrence dropped from 40 to 60 percent down to 15.4 percent.
The Vanderbilt physicians who carried out the study further hypothesized that using CRP to measure APR can be applied across disease states and patients populations. CRP has previously been found to be associated with increased risk of VTE for adult cancer patients.
“Future studies will focus on if CRP can predict thrombosis prospectively and if patients with threshold CRP can be treated prophylactically, avoiding thrombotic complications,” Schoenecker said.