2010, Number 2
Usefulness of C reactive protein and erythrocyte sedimentation rate for the detection of osteomyelitis in diabetic foot
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ABSTRACTIntroduction: One of the major problems in diabetic foot is osteomyelitis. Many non-invasive, indirect, reliable and widely available biomarkers have been tested, being some of these the erythrocyte sedimentation rate (ESR) and the C reactive protein (CRP). Objectives: Compare serum levels of CRP and ESR as indicators of osteomyelitis in patients with diabetic foot. Material and methods: Clinical files in the Hospital General Dr. Manuel Gea González with the diagnosis of diabetic foot were analyzed in the period between January 2005 and December 2009. Clinical, laboratory and radiological variables were registered, being analyzed with the outcomes of amputation and osteomyelitis. Results: Eighty patients were included in the analysis. The time of the diagnosis of diabetes was 7.6 years. The main comorbidities were smoking (51% of patients), previous amputation (40%) and hypertension (32.5%). Radiological changes compatible with osteomyelitis were seen in 18 patients (22.5%). Forty six patients (57.5%) had surgical amputation. Twenty eight patients without radiological signs of osteomyelitis had amputation. The hystopathological study reported osteomyelitis in 19.5%, soft tissue infection in 8.7% and atherosclerosis in 58.7%. In relation to the surgical outcome, there was statistical significance for amputation with high concentrations of CRP (10.7 ± 8 vs 5.6 ± 5.8, p = 0.004), marginally with ESR (83.1 ± 5 vs 64.8 ± 39, p = 0.04), more time of diabetes (11.1 ± 9 vs 2.4 ± 2.5, p = 0.00) and presence of leucocytosis (13.8 ± 6 vs 8.4 ± 4, p = 0.00). In the ROC analysis for osteomyelitis, the area for CRP was 0.551 (IC 95%, 0.36-0.75) and for ESR was 0.712 (IC 95%, 0.55-0.87). Conclusion: Patients with diabetic foot present many cardiovascular risk factors and micro and macrovascular complications associated with diabetes. The risk factors associated with amputation were longer history of diabetes, high levels of CRP and leucocytosis. The ESR has a greater diagnostic value for osteomyelitis than CRP.
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