The infected diabetic foot: Can serum biomarkers predict osteomyelitis after
hospital discharge for diabetic foot infections?
Authors Crisologo PA, Davis KE, Ahn J, Farrar D, Van Asten S, La Fontaine J, Lavery LA
Submitted By Submitted Externally on 8/11/2020
Status Published
Journal Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society, REFERENCES
Year 2020
Date Published 7/1/2020
Volume : Pages Not Specified : Not Specified
PubMed Reference 32698253
Abstract 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 ?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?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.