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J Foot Ankle Surg. 2019 Jan 23. pii: S1067-2516(18)30429-0. doi: 10.1053/j.jfas.2018.09.025. [Epub ahead of print]

Diagnostic Utility of Erythrocyte Sedimentation Rate and C-Reactive Protein in Osteomyelitis of the Foot in Persons Without Diabetes.

Author information

1
Student, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: easton.ryan@utsouthwestern.edu.
2
Student, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
3
Surgeon, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
4
Surgeon, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC.
5
Surgeon, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Abstract

The aim of the study was to assess the diagnostic value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels in differentiating foot osteomyelitis (OM) from soft tissue infection (STI) in persons without diabetes. We evaluated 102 patients in a retrospective cohort study of nondiabetic patients admitted to our institution with OM (n = 51) and with STI (n = 51). Patient diagnosis was determined through bone culture and/or histopathology for OM and magnetic resonance scan and/or single-photon emission computed tomography for STI. Cutoffs for ESR and CRP to predict OM as identified by receiver operating characteristic were 45.5 mm/h and 3.45 mg/dL, respectively. The ESR cutoff demonstrated a sensitivity and specificity of 49% and 79%, while the values for CRP were 45% and 71%, respectively. The combined sensitivity and specificity for ESR and CRP were 33% and 84%. The positive and negative predictive values were 68% and 60% for ESR and 61% and 56% for CRP, respectively. In conclusion, ESR and CRP demonstrate poor sensitivity and specificity for detecting OM in the nondiabetic foot. These markers have little diagnostic utility in the nondiabetic foot.

KEYWORDS:

biomarkers; foot infection

PMID:
30685423
DOI:
10.1053/j.jfas.2018.09.025

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