DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE OF PINP AND Β-CROSSLAPS IN PEDIATRIC ACUTE HEMATOGENOUS OSTEOMYELITIS.
Abstract
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.