The Diagnostic Value Of Serum Hypersensitive C-reactive Protein In Diabetic Foot Osteomyelitis Patients

Objective: The analysis for the correlation and diagnostic value of hypersensitive C-reactive protein(hs-CRP)and diabetic foot osteomyelitis(DFO) so that the doctor may discover DFO as soon as possible and adopt relevant measures with shortening hospitalization, reducing hospitalization costs, saving medical resource, lowering the rate of amputation and mortality.Methods: A total of 76 patients diagnosed with diabetic foot(DF) who hospitalized in Metabolic Hospital of Tianjin Medical University from April 2015 to September 2015 were enrolled. All DF patients were treated by comprehensive ways including the metabolic control, improving blood circulation, anti-microbial treatment, surgical interventions, decompression therapy. 50 patients met the strict inclusion and exclusion criteria. According to diagnostic criteria, 29 cases were divided into the DFO group and 21 cases were divided into the non-DFO group.The general information and inflammatory indicators of patients were collected, and then analyzed them. Differences of general information among two groups were compared.The level of baseline and post-treatment CRP, white blood cell(WBC), Erythrocyte Sedimentation Rate(ESR) were compared. The related factors of DFO were further analyzed. Receiver operating characteristic(ROC) curves were generated to compare the predictability of serum CPR, WBC, ESR for DFO. The maximum values of Youden index that the best cut-off values of DFO was calcuated and sensitivity and specificity were respectively acquired. P<0.05 was statistically significant.Results: 1.The comparison of general information between DFO group and non-DFO group, there are not difference in age, sex, diabetes mellitus(DM)course, diabetic foot ulcer(DFU) course, multiple ulcers, ulcer history, amputation history, smoking history, hypertension, coronary heart disease, cerebrovascular disease, diabeticnephropathy, diabetic retinopathy. High level of glycosylated haemoglobin A1c(Hb A1c), fibrinogen(FIB) is in DFO group. Compared with DFO group, more patients were with dyslipidemia. Differences are statistically significant(P<0.05).Spearman correlation coefficient further analyse that there was no correlation between DFO and Hb A1 c level, however, DFO showed positive correlation with the level of FIB as well as dyslipidemia, Spearman correlation coefficient(rs) is 0.466 and 0.343 respectively.2.The comparison of inflammatory indicators between DFO group and non-DFO group, the serum CRP, WBC,ESR level is higher in DFO group than non-DFO group. Spearman correlation coefficient further analyse that DFO showed positive correlation with the level of baseline CRP, WBC and ESR(P<0.05), rs is 0.370,0.346 and 0.335 respectively, CRP has the better correlation.3.The comparison of baseline and post-treatment CRP, WBC, ESR level,ESR has not statistically significant, but CRP and WBC significantly decline(P<0.05).4.The ROC curve were generated to calculated the baseline CRP, WBC, ESR area that is 0.721,0.674,0.705 respectively. the best cut-off values of baseline CRP,WBC,ESR were 10.60mg/L(sensitivity and specificity were 70.4% and 71.4% respectively),8.43×109/L(sensitivity and specificity were 51.7% and 85.7% respectively) and 39mm/h(sensitivity and specificity were 71.4% and 63.6% respectively).Conclusion: The possibility of merging osteomyelitis is the greater with the baseline level of FIB,CRP, WBC and ESR increase in patients with DFO.DF patients merging dyslipidemia increase the possibility of DFO. The serum CRP and WBC count significantly decreased 28 days after the treatment, ESR has not significantly decreased that means it may be a better indicator of long-term prognosis.To an extent,the level of serum baseline CRP,WBC and ESR has the predictive value for DFO.ESR and CRP have more higher sensitivity which helps improve the detection rate and reduce the rate of missed diagnosis.WBC count have more higher specificity which helps reduce misdiagnosis rate.Combination the medical history, clinical characteristic and serum inflammation indicators could help the doctors to make patients get a good diagnosis and treatment, reducing the rate of amputation and improving the prognosis of patients.