To explore the serum vitamin C level in children with acute hematogenous osteomyelitis (AHO) and its influencing factors.

A total of 64 AHO children who underwent surgery at Jinan Children′s Hospital from January 2020 to March 2023 were selected as research subjects. Gender, age, lesion site, and laboratory test results at admission, including routine blood tests, coagulation functions, serum vitamin C levels, C-reactive protein (CRP), and erythrocyte sedimentation rate were retrospectively collected. Serum vitamin C levels were quantitatively analyzed by ultra-high-performance liquid chromatography-tandem mass spectrometry. Comparison of serum vitamin C levels between AHO children with different clinical characteristics was performed by Mann-Whitney U test. Spearman rank correlation analysis was used to explore the correlation between laboratory test results and serum vitamin C levels. Receiver operating characteristic (ROC) curve of laboratory test results to predict the occurrence of serum vitamin C deficiency in AHO children was plotted, and area under the curve (AUC) was calculated to assess the accuracy of laboratory test results in predicting serum vitamin C deficiency in AHO children. The procedures followed in this study complied with the ethical standards established by the Ethics Committee of Jinan Children′s Hospital and received approval from the committee (Approval No. SDFE-IRB/T-2023080).

①Among 64 AHO children, all were accompanied by migratory or provocative pain symptoms, the median age was 5.9 years, with 34 males and 30 females, and the median serum vitamin C level was 3.10 μg/mL (lower than the normal range), and all were accompanied by pain symptoms. ②Results of the comparison of serum vitamin C levels in AHO children with different clinical characteristics showed that serum vitamin C level in male children was lower than that in female children, and serum vitamin C level in AHO children with lesions in long tubular bones was lower than that of children with lesions in non-long tubular bones, and both the differences were statistically significant (Z=-2.22, P=0.026; Z=-2.42, P=0.016). ③Spearman rank correlation analysis showed that the white blood cell count, neutrophil count, fibrinogen level, erythrocyte sedimentation rate in AHO children were negatively correlated with their serum vitamin C levels (r_s=-0.412, P=0.001; r_s=-0.424, P=0.001; r_s=-0.246, P=0.049; r_s=-0.267, P=0.033). ④ROC curve analysis showed that the AUC of neutrophil count in predicting serum vitamin C deficiency in AHO children was 0.753 (95%CI: 0.629-0.852, P<0.001). According to the principle of maximum Youden index, the optimal cutoff value for predicting serum vitamin C deficiency in AHO children was 7.9×10⁹/L, the sensitivity for diagnosis of serum vitamin C deficiency in AHO children was 65.2%, and the specificity was 83.3%.

The serum vitamin C level in AHO children is significantly decreased. Being male, having AHO lesions in long tubular bones, accompanied by migratory or provocative pain symptoms, and having a neutrophil count >7.9×10⁹ /L may be risk factors for serum vitamin C deficiency in AHO children.