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The values of leukocyte count, C-reactive protein, and erythrocyte sedimentation rate for diagnosis of osteomyelitis in patients with diabetic foot ulcers

Abstract number: P1151

Yapar N., Akinci B., Ay B., Yener S., Yesil S.

Objectives: Diabetic foot infections are serious problems in diabetic patients and osteomyelitis is not a rare complication of these infections. In this study, we aimed to investigate the diagnostic values of WBC count, C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) for diagnosis of osteomyelitis.

Methods: Patients admitted to our hospital with diabetic foot ulcers in three years period, from January 2004 to December 2006, were included in the study. Demographical data, duration and classification of foot ulcer, WBC counts, ESRs, and CRP levels were recorded. Reference values of tests were 0–5 mg/dL for CRP and 0–20 mm/h for ESR. Osteomyelitis was diagnosed according to the radiological findings (X-ray and MRI). Sensitivities, specificities, positive and negative predictive values (PPV and NPV) of laboratory tests were calculated.

Results: In the study period 142 patients were admitted to the hospital with complaints of diabetic foot infection. Of these patients, 100 (70.4%) were male, 42 (29.6%) were female and mean age of patients was 62.28±11.34 (35–88). Duration of ulcers were shorter than one week in 19 (13.4%), 1–4 weeks in 38 (26.8%) and longer than four weeks in 84 (59.2%) of patients. Osteomyelitis was diagnosed in 52 (36.6%) patients and 35 (67.3%) patients with ostemyelitis had ulcer for more than four weeks. For diagnosis of osteomyelitis, sensitivity, specificity, PPV and NPV of WBC, CRP, and ESR levels were summarised in the table.

Table. Sensitivity, specificity, PPV and NPV percentages of laboratory tests

Conclusions: ESR and CRP levels had very low specificities (8.8% for ESR and 15.5% for CRP) but their sensitivities were comparatively high (94.2% for ESR and 90.3% for CRP). When different levels of ESR (higher than 75 mm/h) and CRP (higher than 100 mg/dL) were taken in to consideration we realised an elevation in their values. We concluded that none of these tests has high sensitivity and specificity alone. But for evaluation of a patient with diabetic foot ulcer, especially with longer duration, they should be considered together.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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