C-Reactive protein predicts risk of venous thromboembolism in pediatric musculoskeletal infection

Background: The rate of venous thromboembolism in children with musculoskeletal infections (MSKIs) is markedly elevated compared with hospitalized children in general. Predictive biomarkers to identify high-risk patients are needed to prevent the significant morbidity and rare mortality associated with thrombotic complications. We hypothesize that overactivation of the acute phase response is associated with the development of pathologic thrombi and we aim to determine whether elevations in C-reactive protein (CRP) are associated with increased rates of thrombosis in pediatric patients with MSKI. Methods: A retrospective cohort study measuring CRP in pediatric MSKI patients with or without thrombotic complications. Results: The magnitude and duration of elevation in CRP values correlated with the severity of infection and the development of pathologic thrombosis. In multivariable logistic regression, every 20 mg/L increase in peak CRP was associated with a 29% increased risk of thrombosis (P>0.001). Peak and total CRP were strong predictors of thrombosis with area under the receiveroperator curves of 0.90 and 0.92, respectively. Conclusions: Future prospective studies are warranted to further define the discriminatory power of CRP in predicting infectionprovoked thrombosis. Pharmacologic prophylaxis and increased surveillance should be strongly considered in patients with MSKI, particularly those with disseminated disease and marked elevation of CRP. Level of Evidence: Level III.