Decreased accuracy of erythrocyte sedimentation rate in diagnosing osteomyelitis in diabetic foot infection patients with severe renal impairment: A retrospective cross-sectional study

Abstract

Background Rapid diagnosis and treatment of diabetic foot osteomyelitis (DFO) could reduce the risk of amputation and death in patients with diabetic foot infection (DFI). Erythrocyte sedimentation rate (ESR) is considered the most useful serum inflammatory marker for the diagnosis of DFO. However, whether severe renal impairment (SRI) affects its diagnostic accuracy has not been reported previously. Objective To investigate the accuracy of ESR in diagnosing DFO in DFI patients with and without SRI. Methods This was a retrospective cross-sectional study. From the inpatient electronic medical record system, the investigators extracted demographic information, diagnostic information, and laboratory test results of patients with DFI who had been hospitalized in Longhua Hospital from January 1, 2016 to September 30, 2021. Logistic regression was performed to analyze the interaction between ESR and SRI with adjustment for potential confounders. The area under the curve (AUC), cutoff point, sensitivity, specificity, prevalence, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR−) were analyzed by receiver operating characteristic (ROC) curve analysis and VassarStats. Results A total of 364 DFI patients were included in the analysis. The logistic regression analysis results showed that elevated ESR increased the probability of diagnosing DFO (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.75–3.28; adjusted P < 0.001); SRI was not associated with the diagnosis of DFO (adjusted OR, 3.20; 95% CI, 0.40–25.32; adjusted P = 0.271), but it had an obstructive effect on the diagnosis of DFO by ESR (adjusted OR, 0.48; 95% CI, 0.23–0.99; adjusted P = 0.048). ROC analysis in DFI patients without SRI revealed that the AUC of ESR to diagnose DFO was 0.76 (95% CI, 0.71–0.81), with the cutoff value of 45 mm/h (sensitivity, 67.8%; specificity, 78.0%; prevalence, 44.7%; PPV, 71.3%; NPV, 75.0%; LR+, 3.08; LR−, 0.41). In contrast, in patients with SRI, the AUC of ESR to diagnose DFO was 0.57 (95% CI, 0.40–0.75), with the cutoff value of 42 mm/h (sensitivity, 95.0%; specificity, 29.2%; prevalence, 45.5%; PPV, 52.8%; NPV, 87.5%; LR+, 1.34; LR−, 0.17). Conclusions The accuracy of ESR in diagnosing DFO in DFI patients with SRI is reduced, and it may not have clinical diagnostic value in these patients.

Difficulties in the Treatment of Diabetic Foot and Research Progress of Combination of Traditional Chinese and Western Medicine

“…Acupuncture Treatment. Tang Xiaohui et al through meta-analysis concluded that moxibustion has a significant clinical effect in the treatment of diabetic foot [45]. According to the method of random number table, 80 patients with DF were divided into the experimental group and the control group [46].…”

Biochemical predictors of diabetic foot osteomyelitis: A potential diagnostic role for parathormone

“…14,25 The most commonly used parameters are erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white cell count (WCC), although their circulating levels may be altered in several conditions with differences in sensitivity and specificity. 11,14 Of note, among bone turnover markers, there were no differences in vitamin D serum levels between the study groups. This result may be related to the high rate of vitamin D deficiency/insufficiency in patients with diabetes.…”

“…Among biochemical markers, acute phase reactants, which are produced by the liver during inflammatory states, may be measured to distinguish non‐infected ulcers, DFI, and OM 14,25 . The most commonly used parameters are erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), and white cell count (WCC), although their circulating levels may be altered in several conditions with differences in sensitivity and specificity 11,14 . Of note, among bone turnover markers, there were no differences in vitamin D serum levels between the study groups.…”

“…10 Specifically, OM is observed in almost 20% of patients with DFI, leading to a significant increase in amputation and mortality rate. 11 Therefore, an early and accurate diagnosis is mandatory to reduce the risk of LEAs and their related adverse events. 12 The diagnosis of OM remains challenging, due to the complexity of its clinical manifestations.…”

“…Moreover, DFI may affect soft tissues or spread to underlying bone, resulting in osteomyelitis (OM), which often requires a surgical approach and prolonged antibiotic treatments 10 . Specifically, OM is observed in almost 20% of patients with DFI, leading to a significant increase in amputation and mortality rate 11 . Therefore, an early and accurate diagnosis is mandatory to reduce the risk of LEAs and their related adverse events 12 .…”