PLoS ONE (Jan 2022)

Decreased accuracy of erythrocyte sedimentation rate in diagnosing osteomyelitis in diabetic foot infection patients with severe renal impairment: A retrospective cross-sectional study

  • Xin Chen,
  • Yiting Shen,
  • Yuying Wang,
  • Yang Li,
  • Shuyu Guo,
  • Yue Liang,
  • Xuanyu Wang,
  • Siyuan Zhou,
  • Xiaojie Hu,
  • Kaiwen Ma,
  • Rui Tian,
  • Wenting Fei,
  • Yuqin Sheng,
  • Hengjie Cao,
  • Huafa Que

Journal volume & issue
Vol. 17, no. 3

Abstract

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Background Rapid diagnosis and treatment of diabetic foot osteomyelitis (DFO) could reduce the risk of amputation and death in patients with diabetic foot infection (DFI). Erythrocyte sedimentation rate (ESR) is considered the most useful serum inflammatory marker for the diagnosis of DFO. However, whether severe renal impairment (SRI) affects its diagnostic accuracy has not been reported previously. Objective To investigate the accuracy of ESR in diagnosing DFO in DFI patients with and without SRI. Methods This was a retrospective cross-sectional study. From the inpatient electronic medical record system, the investigators extracted demographic information, diagnostic information, and laboratory test results of patients with DFI who had been hospitalized in Longhua Hospital from January 1, 2016 to September 30, 2021. Logistic regression was performed to analyze the interaction between ESR and SRI with adjustment for potential confounders. The area under the curve (AUC), cutoff point, sensitivity, specificity, prevalence, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR−) were analyzed by receiver operating characteristic (ROC) curve analysis and VassarStats. Results A total of 364 DFI patients were included in the analysis. The logistic regression analysis results showed that elevated ESR increased the probability of diagnosing DFO (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.75–3.28; adjusted P Conclusions The accuracy of ESR in diagnosing DFO in DFI patients with SRI is reduced, and it may not have clinical diagnostic value in these patients.