Skip to main content Skip to main navigation menu Skip to site footer

Lactate Dehydrogenase (LDH) dan prokalsitonin merupakan parameter pembeda yang lebih spesifik dan sensitif dibandingkan dengan Laju Endap Darah (LED), C-Reactive Protein (CRP), dan Alkaline Phosphatase (ALP) antara osteosarkoma dan osteomielitis di RSUP S

  • Ivander Purvance ,
  • Putu Astawa ,
  • Made Bramantya Karna ,
  • I Ketut Siki Kawiyana ,
  • Ketut Gede Mulyadi Ridia ,
  • I Ketut Suyasa ,
  • I Wayan Suryanto Dusak ,
  • I Gede Eka Wiratnaya ,


Background: It is often difficult to distinguish between the clinical presentation of osteosarcoma and osteomyelitis in the early stages. Histopathological review, requiring planning, delaying early treatment, is the golden standard diagnosis for this disorder. This research aimed to find out if it is possible to use simple laboratory examinations to distinguish these diseases. Early treatment can also be carried out, which can lead to a stronger prognosis.

Methods: A medical database of patients with reported osteosarcoma and osteomyelitis was used to collect data. Initial laboratory test results, including erythrocyte sedimentation rate, C-reactive protein, dehydrogenase lactate, alkaline phosphatase, and procalcitonin, were obtained. Statistical analysis was then conducted to determine the most useful laboratory parameter for distinguishing these two diseases. SPSS version 21 for Windows analyzed the results.

Results: The results showed that there was a significant difference between osteosarcoma and osteomyelitis patients' age and body mass index (BMI) (p <0.05). Important variations between all test parameters were found, but the lactate dehydrogenase and procalcitonin parameters were considered to be the most sensitive and specific parameters for the distinction between the two diseases (p<0.05). A sensitivity level of 92.5 % and a specificity of 100% with an AUC value of 0.963 (P = 0.05) were shown to have cut points of 840 U/L for LDH and 0.465 ng/mL for PCT.

Conclusion: Lactate dehydrogenase and procalcitonin have been shown to distinguish between early-stage osteomyelitis and osteosarcoma, making early treatment possible.



Latar Belakang: Gambaran klinis osteosarkoma dan osteomielitis seringkali sulit dibedakan pada fase-fase awal. Pemeriksaan gold standard untuk kedua penyakit ini adalah dengan pemeriksaan histopatologi, namun pemeriksaan ini memerlukan persiapan yang cukup lama, sedangkan tatalaksana kedua penyakit ini optimal bila dilakukan seawal mungkin. Penelitian ini bertujuan untuk melihat apakah pemeriksaan laboratorium sederhana dapat membedakan kedua penyakit ini, sehingga terapi dapat dilakukan sedini mungkin, dan menghasilkan prognosis sebaik mungkin.

Metode: Dilakukan pengambilan data pasien sesuai desain cross sectional analytics, yaitu pasien yang telah terkonfirmasi osteosarkoma dan osteomielitis dari rekam medis. Kemudian dilakukan penelusuran data laboratorium saat awal pasien masuk, yaitu laju endap darah, C-reactive protein, lactate dehydrogenase, alkaline phosphatase, dan prokalsitonin. Kemudian dilakukan analisis statistik untuk menentukan parameter manakah yang paling berperan membedakan kedua penyakit ini. Data dianalisis dengan SPSS versi 21 untuk Windows.

Hasil: Hasil penelitian menunjukkan terdapat perbedaan yang bermakna antara usia dan Indeks Masa Tubuh (IMT) pasien kelompok osteosarkoma dengan osteomielitis (p<0,05). Didapatkan perbedaan yang bermakna dari semua parameter yang diuji, namun parameter lactate dehydrogenase dan prokalsitonin dinilai yang paling sensitif dan spesifik dalam membedakan kedua penyakit tersebut (p<0,05). Titik potong 840 U/L untuk LDH dan 0.465 ng/mL untuk PCT terbukti memiliki tingkat sensitivitas sebesar 92.5% dan spesifisitas 100% dengan nilai AUC 0,963 (P=0,05).

Kesimpulan: Pemeriksaan kadar lactate dehydrogenase dan prokalsitonin terbukti dapat membedakan osteomielitis dan osteosarkoma pada awal proses penyakitnya, sehingga terapi dapat dilakukan lebih dini.


  1. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20(3):776-790.
  2. Birt MC, Anderson DW, Bruce Toby E, Wang J. Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies. J Orthop. 2016;14(1):45-52.
  3. Harris JC, Caesar DH, Davison C, Phibbs R, Than MP. How useful are laboratory investigations in the emergency department evaluation of possible osteomyelitis?. Emerg Med Australas. 2011;23(3):317-330.
  4. Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37 Suppl 2:S59-S66.
  5. Ambroszkiewicz J, Gajewska J, Klepacka T, Che?chowska M, Laskowska-Klita T, Wo?niak W. Clinical utility of biochemical bone turnover markers in children and adolescents with osteosarcoma. Adv Med Sci. 2010;55(2):266-272.
  6. Butbul-Aviel Y, Koren A, Halevy R, Sakran W. Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatr Emerg Care. 2005;21(12):828-832.
  7. Shen CJ, Wu MS, Lin KH, Lin WL, Chen HC, Wu JY, et al. The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2013;32(6):807-814.
  8. Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res. 2009;152:3-13.
  9. Friebele JC, Peck J, Pan X, Abdel-Rasoul M, Mayerson JL. Osteosarcoma: A Meta-Analysis and Review of the Literature. Am J Orthop (Belle Mead NJ). 2015;44(12):547-553.
  10. Altaf S, Enders F, Krailo M, Barkauskas D, Meyers P, Arndt C. Response to "High BMI at diagnosis is associated with inferior survival in patients with osteosarcoma". Pediatr Blood Cancer. 2014;61(5):951.
  11. Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton LJ 3rd, Huddleston PM 3rd. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97(10):837-845.
  12. Li Y, Liu X, Zhang J, Yao W. Prognostic role of elevated preoperative systemic inflammatory markers in localized soft tissue sarcoma. Cancer Biomark. 2016;16(3):333-342.
  13. Maharajan K, Patro DK, Menon J, Hariharan AP, Parija SC, Poduval M, et al. Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. J Orthop Surg Res. 2013;8:19.
  14. Hannisdal E, Solheim OP, Theodorsen L, Høst H. Alterations of blood analyses at relapse of osteosarcoma and Ewing's sarcoma. Acta Oncol. 1990;29(5):585-587.
  15. Jettoo P, Tan G, Gerrand CH, Rankin KS. Role of routine blood tests for predicting clinical outcomes in osteosarcoma patients. J Orthop Surg (Hong Kong). 2019;27(2):2309499019838293.
  16. Yi JH, Wang D, Li ZY, Hu J, Niu XF, Liu XL. C-reactive protein as a prognostic factor for human osteosarcoma: a meta-analysis and literature review. PLoS One. 2014;9(5):e94632.
  17. Nakamura T, Matsumine A, Matsubara T, Asanuma K, Uchida A, Sudo A. Clinical significance of pretreatment serum C-reactive protein level in soft tissue sarcoma. Cancer. 2012;118(4):1055-1061.
  18. Li X, Tian F, Wang F, Li Y. Serum C-reactive protein and overall survival of patients with osteosarcoma. Tumour Biol. 2015;36(7):5663-5666.
  19. Ryan EC, Ahn J, Wukich DK, Kim PJ, La Fontaine J, Lavery LA. Diagnostic Utility of Erythrocyte Sedimentation Rate and C-Reactive Protein in Osteomyelitis of the Foot in Persons Without Diabetes. J Foot Ankle Surg. 2019;58(3):484-488.
  20. van Asten SA, Jupiter DC, Mithani M, La Fontaine J, Davis KE, Lavery LA. Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis. Int Wound J. 2017;14(1):142-148.
  21. Erez A, Shental O, Tchebiner JZ, et al. Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J. 2014;16(7):439-443.
  22. Fu Y, Lan T, Cai H, Lu A, Yu W. Meta-analysis of serum lactate dehydrogenase and prognosis for osteosarcoma. Medicine (Baltimore). 2018;97(19):e0741.
  23. Seker MM, Seker A, Aksoy S, Ozdemir N, Uncu D, Zengin N. Clinicopathologic features and prognosis of osteosarcoma in Turkish adults. Asian Pac J Cancer Prev. 2014;15(8):3537-3540.
  24. Brozmanová E, Skrovina B. Serum enzyme activity in bone tumors and osteomyelitis (LDH, GOT, GPT, CPK, CHE, ALP, AP, PP, ALD). Neoplasma. 1977;24(1):109-117.
  25. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am. 1997;44(4):973-989.
  26. Kim SH, Shin KH, Moon SH, Jang J, Kim HS, Suh JS, et al. Reassessment of alkaline phosphatase as serum tumor marker with high specificity in osteosarcoma. Cancer Med. 2017;6(6):1311-1322.
  27. Bacci G, Longhi A, Versari M, Mercuri M, Briccoli A, Picci P. Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15-year experience in 789 patients treated at a single institution. Cancer. 2006;106(5):1154-1161.
  28. Kamal A, Prasetyo R. Association between laboratory markers and oncological outcomes in patients with osteosarcoma-A review of osteosarcoma treatment in Indonesia. Formos J Surg 2018;51(3):111-117.
  29. de Graeff JJ, Paulino Pereira NR, van Wulfften Palthe OD, Nelson SB, Schwab JH. Prognostic Factors for Failure of Antibiotic Treatment in Patients With Osteomyelitis of the Spine. Spine (Phila Pa 1976). 2017;42(17):1339-1346.
  30. Matzaraki V, Alexandraki KI, Venetsanou K, Piperi C, Myrianthefs P, Malamos N, et al. Evaluation of serum procalcitonin and interleukin-6 levels as markers of liver metastasis. Clin Biochem. 2007;40(5-6):336-342.
  31. Chaftari AM, Hachem R, Reitzel R, Jordan M, Jiang Y, Yousif A, et al. Role of Procalcitonin and Interleukin-6 in Predicting Cancer, and Its Progression Independent of Infection. PLoS One. 2015;10(7):e0130999.
  32. Urbonas V, Eidukait? A, Tamulien? I. The predictive value of soluble biomarkers (CD14 subtype, interleukin-2 receptor, human leucocyte antigen-G) and procalcitonin in the detection of bacteremia and sepsis in pediatric oncology patients with chemotherapy-induced febrile neutropenia. Cytokine. 2013;62(1):34-37.
  33. Cui C, Fu M, Gao B. Procalcitonin and Pancreatic Stone Protein Function as Biomarkers in Early Diagnosis of Pediatric Acute Osteomyelitis. Med Sci Monit. 2017;23:5211-5217.

How to Cite

Purvance, I., Astawa, P., Karna, M. B., Kawiyana, I. K. S., Ridia, K. G. M., Suyasa, I. K., Dusak, I. W. S., & Wiratnaya, I. G. E. (2020). Lactate Dehydrogenase (LDH) dan prokalsitonin merupakan parameter pembeda yang lebih spesifik dan sensitif dibandingkan dengan Laju Endap Darah (LED), C-Reactive Protein (CRP), dan Alkaline Phosphatase (ALP) antara osteosarkoma dan osteomielitis di RSUP S. Intisari Sains Medis, 11(3), 1372–1379.




Search Panel

Ivander Purvance
Google Scholar
ISM Journal

Putu Astawa
Google Scholar
ISM Journal

Made Bramantya Karna
Google Scholar
ISM Journal

I Ketut Siki Kawiyana
Google Scholar
ISM Journal

Ketut Gede Mulyadi Ridia
Google Scholar
ISM Journal

I Ketut Suyasa
Google Scholar
ISM Journal

I Wayan Suryanto Dusak
Google Scholar
ISM Journal

I Gede Eka Wiratnaya
Google Scholar
ISM Journal