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ISSN 0188-9796 (Print)

2010, Number 2

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Rev Endocrinol Nutr 2010; 18 (2)

Usefulness of C reactive protein and erythrocyte sedimentation rate for the detection of osteomyelitis in diabetic foot

García-Ulloa AC, Hernández-Jiménez S, Méndez-García JA, Jesús SMA, Aguilar-Salinas CA, Zacarías-Castillo R

Language: Spanish
References: 27
Page: 90-96
PDF size: 210.87 Kb.


ABSTRACT

Introduction: One of the major problems in diabetic foot is osteomyelitis. Many non-invasive, indirect, reliable and widely available biomarkers have been tested, being some of these the erythrocyte sedimentation rate (ESR) and the C reactive protein (CRP). Objectives: Compare serum levels of CRP and ESR as indicators of osteomyelitis in patients with diabetic foot. Material and methods: Clinical files in the Hospital General Dr. Manuel Gea González with the diagnosis of diabetic foot were analyzed in the period between January 2005 and December 2009. Clinical, laboratory and radiological variables were registered, being analyzed with the outcomes of amputation and osteomyelitis. Results: Eighty patients were included in the analysis. The time of the diagnosis of diabetes was 7.6 years. The main comorbidities were smoking (51% of patients), previous amputation (40%) and hypertension (32.5%). Radiological changes compatible with osteomyelitis were seen in 18 patients (22.5%). Forty six patients (57.5%) had surgical amputation. Twenty eight patients without radiological signs of osteomyelitis had amputation. The hystopathological study reported osteomyelitis in 19.5%, soft tissue infection in 8.7% and atherosclerosis in 58.7%. In relation to the surgical outcome, there was statistical significance for amputation with high concentrations of CRP (10.7 ± 8 vs 5.6 ± 5.8, p = 0.004), marginally with ESR (83.1 ± 5 vs 64.8 ± 39, p = 0.04), more time of diabetes (11.1 ± 9 vs 2.4 ± 2.5, p = 0.00) and presence of leucocytosis (13.8 ± 6 vs 8.4 ± 4, p = 0.00). In the ROC analysis for osteomyelitis, the area for CRP was 0.551 (IC 95%, 0.36-0.75) and for ESR was 0.712 (IC 95%, 0.55-0.87). Conclusion: Patients with diabetic foot present many cardiovascular risk factors and micro and macrovascular complications associated with diabetes. The risk factors associated with amputation were longer history of diabetes, high levels of CRP and leucocytosis. The ESR has a greater diagnostic value for osteomyelitis than CRP.


REFERENCES

  1. Upchurch Gr Jr, Keagy Ba, Johnson G Jr. An acute phase reaction in diabetic patients with foot ulcers. Cardiovasc Surg 1997; 5: 32-36.

  2. Fejfarova V, Hosova J, Striz I, Kalanin J, Skibova J. Analysis Of the inflammation reaction and selected indicators of immunity in patients with an infected diabetic ulcer. Cas Lek Cesk 2002; 141: 483-486.

  3. Got I. Necessary multidisciplinary management of diabetic foot. J Mal Vasc 2001; 26: 130-134.

  4. Meijer JW, Trip J, Jaegers SM, Links TP, Smith AJ, Groothoff JW et al. Quality of life in patients with diabetic foot ulcers. Disabil Rehabil 2001; 23: 336-340.

  5. Åke Sjöholm, Thomas Nyström. Endothelial inflammation in insulin resistance. Lancet 2005; 365: 610-612.

  6. Consensus development conference on diabetic foot wound care. 7-8 April 1999, Boston, MA. American Diabetes Association. Adv Wound Care 1999; 12: 353-361.

  7. Morrison WB, Ledermann HP. Work-up of the diabetic foot. Radiol Clin N Am 2002; 40: 1171-1192.

  8. Firestein: Kelley’s Textbook of Rheumatology, 8th ed 2008.

  9. Lipsky BA, Berendt AR, Deery HG et al. Guidelines for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004; 39: 885-910.

  10. Moran A, Steffen LM, Jacobs DR Jr, Steinberger J et al. Relation of C-reactive protein to insulin resistance and cardiovascular risk factors in youth. Diabetes Care 2005; 28: 1763-1768.

  11. Kang ES, Kim HJ, Ahn CW et al. Relationship of serum high sensitivity C-reactive protein to metabolic syndrome and microvascular complications in type 2 diabetes. Diabetes Res Clin Pract 2005; 69: 151-159.

  12. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-454.

  13. Victor van der Meer, Arie Knuistingh Neven et al. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ, doi:10.1136/bmj.38483.478183.EB (June 2005).

  14. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364: 369-379.

  15. Moss Se, Klein R, Klein BE. The prevalence and incidence of lower extremity amputation in a diabetic population. Arch Intern Med 1992; 152: 610-616.

  16. LeMaster J, Reiber GE. Epidemiología e impacto económico de las úlceras en pie. En: Pie Diabético. Edit El Manual Moderno, 2007: 1-18.

  17. Abott CA, Carrington AL, Ashe H et al. The North-West Diabetes Foot Care Study: incidence and risk factor for new diabetic foot ulceration in a community-based patient cohort. Diabet Med 2002; 19: 377-384.

  18. Hernández-Jiménez S, López-Alvarenga JC, García-García E, Velasco ML, Alvarenga L, Hernández A, Rodríguez-Carranza S González E, Gómez-Pérez FJ, Rull JA. Evaluación de los factores de riesgo para amputación en pacientes hospitali-zados por pie diabético. XLI Reunión Anual de la Sociedad Mexicana de Nutrición y Endocrinología. Pto. Vallarta, Jal. Nov 2001.

  19. Ruiz-Gómez DG, Velásco-Pérez ML, Garduño-García J, Peña-Velarde A, Hernández-Jiménez S, Gómez-Pérez FJ, Rull JA. Evaluación de las características de los pacientes hospitalizados por pie diabético. Experiencia de 22 años del Instituto Nacional de Nutrición «Salvador Zubirán». XLIX Congreso Internacional de la Sociedad Mexicana de Nutrición y Endocrinología, A.C. Monterrey, Nuevo León; noviembre 2009.

  20. Moy CS, LaPorte RE, Dorman JS, Songer TJ, Orchard TJ, Kuller LH, Becker DJ, Drash AL. Insulin-dependent diabetes mellitus mortality. The risk of cigarette smoking. Circulation 1990; 82: 37-43.

  21. Chaturvedi N, Stephenson JM, Fuller JH. The relationship between smoking and microvascular complications in the EURODIAB IDDM Complications Study. Diabetes Care 1995; 18: 785-792.

  22. Mitchell BD, Hawthorne VM, Vinik AI. Cigarette smoking and neuropathy in diabetic patients. Diabetes Care 1990; 13: 434-437.

  23. Standards of medical care in diabetes-2008. Diabetes Care 2008; 31 Suppl 1: S12-S54.

  24. García UAC, Zacarías R. Pie diabético. En: Diabetes. Sistema de Actualización Continua en Endocrinología. Edit. Sociedad Mexicana de Nutrición y Endocrinología, A.C. 2009; http//www.endocrinologia.org.mx

  25. Elizondo J, Rodríguez R, Solís J. Complicaciones vasculares en los pacientes diabéticos. Rev Inv Clin 1965.

  26. De la Garza L, Calles J, Lozano O, Rull JA. Cirugía en extremidad inferior y diabetes mellitus: nivel de amputación y evolución de 306 casos. Rev Cirujano General 1983; 7: 193-197.

  27. García E, Villaseñor J, Castrejón M, Rivera R, Bustamante F, Rull JA. Tratamiento quirúrgico del pie diabético. Análisis de 402 casos. Trabajo libre. Sociedad Mexicana de Nutrición y Endocrinología 1989.




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