The potential role of pan-immune-inflammation value in differentiating pediatric osteomyelitis from soft tissue infections.

BACKGROUND

Distinguishing between pediatric osteomyelitis (OM) and soft tissue infection (STI) remains a diagnostic challenge due to overlapping clinical and laboratory features. The pan-immune-inflammation value (PIV) is a new comprehensive biomarker calculated from counts of blood cells taken from outside the main part of the body, showing the overall condition of the immune system and inflammation in the body. This study aimed to evaluate the diagnostic utility of PIV in differentiating OM from STI in children.

METHODS

The retrospective study conducted a review of past data involving children who visited Department of Orthopedics, Center for Children's Health, Capital Medical University from January 2020 to May 2025. The cohort consisted of 59 children with OM and 310 with STI. Demographic, clinical, and laboratory parameters were systematically collected for all participants. PIV was calculated and analyzed.

RESULTS

The OM group showed higher PIV levels compared to the STI group (512.6±198.4 vs. 220.3±115.7, P<0.001). Multivariate analysis identified PIV as an independent predictor for OM [odds ratio (OR) =1.012, 95% confidence interval (CI): 1.008-1.016, P<0.001]. The area under the receiver operating characteristic (ROC) curve (AUC) for PIV was 0.892 (95% CI: 0.845-0.939), with a sensitivity of 84.7% and specificity of 82.3% at the optimal cutoff value of 385.6. The combination of PIV with C-reactive protein (CRP) further improved diagnostic accuracy (AUC =0.926).

CONCLUSIONS

PIV is a promising, readily available biomarker that shows potential to effectively differentiate pediatric OM from STIs, potentially aiding in early diagnosis and appropriate management upon further validation.