Erythrocyte Sedimentation Rate and C-Reactive Protein to Monitor Treatment Outcomes in Diabetic Foot Osteomyeltis
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PURPOSE: To evaluate the effectiveness of the inflammatory markers Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) in monitoring treatment of osteomyelitis in the diabetic foot. METHODOLOGY: We screened 150 charts of patients admitted to our hospital with diabetic foot osteomyelitis (DFO), confirmed by positive results of bone culture and/or histopathology. We included patients who had an initial ESR/CRP within 72 hours of admission and 2 reported follow-up values. We dichotomized patients based on the outcomes wound healing, re-infection, recurrent ulceration, re-hospitalization, additional surgery, re-amputation, death, all within 12 months, and analyzed the trajectories of the markers over time. Our primary outcome, DFO remission, was defined as wound healing within 12 months follow up without re-infection. PROCEDURES: None RESULTS: We included 122 subjects, 65 patients (53.3%) had a combination of positive culture and histopathology. Factors associated with DFO remission (n=46, 37.7%) were a lower white blood count (WBC) at admission (p=0.006), and a higher glomerular filtration rate (GFR, p=0.049). Factors associated with healing were a lower WBC (p=0.004), a higher GFR (p=0.01), longer wound duration before admission (p=0.01), location of the ulcer on the great toe (p=0.01), and higher glycated haemoglobin (p=0.03). Logistic regression analysis demonstrated no associations between DFO remission and other variables collected. Trajectories of the inflammatory markers showed an association between stagnating values of ESR and CRP and poor clinical outcomes. DISCUSSION: In this study population, the trajectories of both ESR and CRP during the 12-month follow-up suggest a predictive role of inflammatory markers when monitoring treatment of DFO.