The Diagnosis of Osteomyelitis in Diabetes Using Erythrocyte Sedimentation Rate

Abstract

Osteomyelitis secondary to diabetic foot infections can lead to proximal amputation if not diagnosed in a timely and accurate manner. The authors have found no studies to date that correlate a specific erythrocyte sedimentation rate with osteomyelitis. A retrospective chart review of 29 diabetic patients admitted to the hospital with diagnoses of osteomyelitis or cellulitis of the foot during a 1-year period was performed. Of the various lab values and demographic factors compared, erythrocyte sedimentation rate was the only measure that differed significantly between the two groups. A receiver operating characteristic curve was used to obtain the optimal cutoff value of 70 mm/h, a level above which osteomyelitis was present with the highest sensitivity (89.5%) and highest specificity (100%), along with a positive predictive value of 100% and a negative predictive value of 83%. This study shows that in combination with clinical suspicion in diabetic foot infections, the erythrocyte sedimentation rate is highly predictive of osteomyelitis, and that the value of 70 mm/h is the optimal cutoff to predict accurately the presence or absence of bone infection.

Procalcitonin as a Diagnostic Aid in Diabetic Foot Infections

“…In this study, WBC and ESR exhibited moderate sensitivity and specifi city for DFI. Kaleta et al (2001) showed that an ESR greater than 70 mm/h has a sensitivity of 89.5% and a specifi city of 100% for osteomyelitis in diabetic patients. We determined osteomyelitis in seven patients in the DFI group.…”

Diagnosis and Treatment of Diabetic Foot Infections

“…In patients with a limbthreatening infection, positive results of a probe-to-bone test may be taken as nearly sufficient for diagnosis, but the performance characteristics of this test have not yet been fully defined. A swollen foot in a patient with a history of foot ulceration, a "sausage toe" (i.e., a red, swollen digit) [246], or an unexplained high WBC count [235] or inflammatory markers [236] should also arouse suspicion of osteomyelitis (B-II). Finally, radiologically evident bone destruction beneath an ulcer should be considered to represent osteomyelitis unless proven otherwise [247].…”

“…The primary indicators of improvement are resolution of local and systemic symptoms and clinical signs of inflammation. Blood test findings, including WBC counts [234,235] and inflam- matory markers, such as the erythrocyte sedimentation rate [122,236,237] and the C-reactive protein level [238], are of limited use for monitoring response, although is it reassuring to see elevated levels decrease and cause for concern when they do not. When a hospitalized patient is ready for discharge or an outpatient returns for follow-up, the clinician should accomplish 4 tasks (figures 1, 2, and 4).…”

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

“…27,28 Kaleta et al suggested that an ESR level of 70 mm/h might be the optimal cutoff point to predict osteomyelitis with sensitivity of 89.5% and specificity of 100%. 29 The cut-off level of 90 mm/h for ESR had fair specificity for the prediction of major amputation.…”

“…25,30 The sensitivity of this finding was only 28% in one study and was less than 50% in another study. [29][30][31] Yesil S et al showed that the cut-off level of 90 mm/h for ESR had fair specificity for the prediction of major lower extremity amputations. 32 Another study of severe diabetic foot infections reported that the mean ESR in cases with osteomyelitis was only 56 mm/h.…”