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The infected diabetic foot: Can serum biomarkers predict osteomyelitis after hospital discharge for diabetic foot infections?
Author(s) -
Crisologo Peter Andrew,
Davis Kathryn E.,
Ahn Junho,
Farrar David,
Van Asten Suzanne,
La Fontaine Javier,
Lavery Lawrence A.
Publication year - 2020
Publication title -
wound repair and regeneration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.847
H-Index - 109
eISSN - 1524-475X
pISSN - 1067-1927
DOI - 10.1111/wrr.12836
Subject(s) - procalcitonin , medicine , erythrocyte sedimentation rate , white blood cell , gastroenterology , osteomyelitis , diabetic foot , c reactive protein , receiver operating characteristic , diabetes mellitus , surgery , sepsis , inflammation , endocrinology
The aim of this study is to evaluate serum biomarkers to monitor high‐risk patients for reinfection of bone. Thirty‐five patients were prospectively enrolled with moderate to severe diabetic foot infections with suspicion of osteomyelitis. Bone samples were obtained for culture and histology. Clinical characteristics and outcomes of patients were compared using χ 2 square test. Biomarkers (white blood cell count, erythrocyte sedimentation rate, c‐reactive protein, procalcitonin, interleukin‐6, interleukin‐8, and monocyte chemoattractant protein 1) were assessed at baseline, 3, and 6 weeks after treatment initiation and evaluated for correlation with reinfection of bone. After 6 weeks of antibiotic treatment, ESR at 73.5 mm/h (sensitivity 62.5%, specificity 100%, area under the receiver operating characteristic (AUROC) 0.7839, 95% CI 0.54‐1.00, P < .01) and IL‐8 at 15.09 mg/dL (sensitivity 42.9%, specificity 92.0% AUROC 0.6286, 95% CI 0.36‐0.90, P = .0496) were associated with reinfection of bone. An increase in IL‐8 from week 0 to 6 >0.95 mg/dL was associated with reinfection (sensitivity 71%, specificity 72% AUROC 0.7057, 95% CI 0.49‐0.92, P = .04). An ESR change from week 0‐6 of −16.5% (sensitivity 71.4%, specificity 86.4% AUROC 0.7403, 95% CI 0.48‐1.00, P = .02), CRP (‐)74.4% (sensitivity 66.7%, specificity 91.3% AUROC 0.7174, 95% CI 0.40‐1.00, P = .04), IL‐6 (‐)49.9% (sensitivity 71.4%, specificity 76% AUROC 0.7371, 95% CI 0.47‐1.00, P = .04), and IL‐8 29% (sensitivity 85.7%, specificity 56.0% AUROC of 0.7343, 95% CI 0.54‐0.93, P = .048) were associated with increased risk of reinfection. Pilot data suggest that serum biomarkers (ESR, IL8 and IL6, MCP‐1) may be correlated with developing osteomyelitis and could be used to monitor high‐risk patients for reinfection.