Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis

Suzanne Av van Asten, Daniel Jupiter, Moez Mithani, Javier La Fontaine, Kathryn E. Davis, Lawrence A. Lavery

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

This study sought 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. 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 two reported follow-up values. We dichotomised patients based on the outcomes wound healing, re-infection, recurrent ulceration, re-hospitalisation, additional surgery, re-amputation and death, all within 12 months, and analysed the trajectories of the markers over time. Our primary outcome, DFO remission, was defined as wound healing within 12 months of follow-up without re-infection. We included 122 subjects; 65 patients (53·3%) had a combination of positive culture and histopathology. Factors associated with DFO remission (n = 46) 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. In this study population, the trajectories of both ESR and CRP during 12 months follow-up suggest a predictive role of both inflammatory markers when monitoring treatment of DFO.

Original languageEnglish (US)
JournalInternational Wound Journal
DOIs
StateAccepted/In press - 2016

Fingerprint

Diabetic Foot
Blood Sedimentation
Osteomyelitis
C-Reactive Protein
Wound Healing
Hallux
Glycosylated Hemoglobin A
Infection
Glomerular Filtration Rate
Amputation
Ulcer
Hospitalization
Logistic Models
Regression Analysis
Bone and Bones
Wounds and Injuries
Therapeutics
Population

Keywords

  • Biomarkers
  • C-reactive protein
  • Diabetic foot infection
  • Erythrocyte sedimentation rate
  • Osteomyelitis

ASJC Scopus subject areas

  • Surgery
  • Dermatology

Cite this

Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis. / van Asten, Suzanne Av; Jupiter, Daniel; Mithani, Moez; La Fontaine, Javier; Davis, Kathryn E.; Lavery, Lawrence A.

In: International Wound Journal, 2016.

Research output: Contribution to journalArticle

van Asten, Suzanne Av ; Jupiter, Daniel ; Mithani, Moez ; La Fontaine, Javier ; Davis, Kathryn E. ; Lavery, Lawrence A. / Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis. In: International Wound Journal. 2016.
@article{dd34792442a947b0a0442256f3c95a4d,
title = "Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis",
abstract = "This study sought 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. 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 two reported follow-up values. We dichotomised patients based on the outcomes wound healing, re-infection, recurrent ulceration, re-hospitalisation, additional surgery, re-amputation and death, all within 12 months, and analysed the trajectories of the markers over time. Our primary outcome, DFO remission, was defined as wound healing within 12 months of follow-up without re-infection. We included 122 subjects; 65 patients (53·3{\%}) had a combination of positive culture and histopathology. Factors associated with DFO remission (n = 46) 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. In this study population, the trajectories of both ESR and CRP during 12 months follow-up suggest a predictive role of both inflammatory markers when monitoring treatment of DFO.",
keywords = "Biomarkers, C-reactive protein, Diabetic foot infection, Erythrocyte sedimentation rate, Osteomyelitis",
author = "{van Asten}, {Suzanne Av} and Daniel Jupiter and Moez Mithani and {La Fontaine}, Javier and Davis, {Kathryn E.} and Lavery, {Lawrence A.}",
year = "2016",
doi = "10.1111/iwj.12574",
language = "English (US)",
journal = "International Wound Journal",
issn = "1742-4801",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis

AU - van Asten, Suzanne Av

AU - Jupiter, Daniel

AU - Mithani, Moez

AU - La Fontaine, Javier

AU - Davis, Kathryn E.

AU - Lavery, Lawrence A.

PY - 2016

Y1 - 2016

N2 - This study sought 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. 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 two reported follow-up values. We dichotomised patients based on the outcomes wound healing, re-infection, recurrent ulceration, re-hospitalisation, additional surgery, re-amputation and death, all within 12 months, and analysed the trajectories of the markers over time. Our primary outcome, DFO remission, was defined as wound healing within 12 months of follow-up without re-infection. We included 122 subjects; 65 patients (53·3%) had a combination of positive culture and histopathology. Factors associated with DFO remission (n = 46) 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. In this study population, the trajectories of both ESR and CRP during 12 months follow-up suggest a predictive role of both inflammatory markers when monitoring treatment of DFO.

AB - This study sought 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. 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 two reported follow-up values. We dichotomised patients based on the outcomes wound healing, re-infection, recurrent ulceration, re-hospitalisation, additional surgery, re-amputation and death, all within 12 months, and analysed the trajectories of the markers over time. Our primary outcome, DFO remission, was defined as wound healing within 12 months of follow-up without re-infection. We included 122 subjects; 65 patients (53·3%) had a combination of positive culture and histopathology. Factors associated with DFO remission (n = 46) 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. In this study population, the trajectories of both ESR and CRP during 12 months follow-up suggest a predictive role of both inflammatory markers when monitoring treatment of DFO.

KW - Biomarkers

KW - C-reactive protein

KW - Diabetic foot infection

KW - Erythrocyte sedimentation rate

KW - Osteomyelitis

UR - http://www.scopus.com/inward/record.url?scp=84959888784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959888784&partnerID=8YFLogxK

U2 - 10.1111/iwj.12574

DO - 10.1111/iwj.12574

M3 - Article

JO - International Wound Journal

JF - International Wound Journal

SN - 1742-4801

ER -