Does everything that’s counted count? The value of inflammatory markers in diabetic foot infections

This just published from our combined teams.

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Abstract:

To assess the severity of inflammation associated with diabetic foot infection (DFI), values of inflammatory markers such as white blood count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR) are often measured and tracked over time. It remains unclear if these markers can aid the clinician in the diagnosis and management of DFI, and ensure more rational use of antibiotics. Hospitalized adult patients (n = 379) with DFI were retrospectively assessed for abnormal inflammatory markers, correlation between values of inflammatory markers, and clinical diagnosis on initial admission and on last follow-up. At admission, WBC, ESR and NLR were each elevated in patients with osteomyelitis and only ESR was significantly elevated in patients with soft tissue infection only. Only WBC was significantly elevated in patients with osteomyelitis compared with uninfected diabetic feet on last follow-up. Considering the predictive performance of these inflammatory markers, they demonstrated excellent positive predictive value at admission, and excellent negative predictive value at the last follow-up visit. Moreover, the number of elevated markers was further associated with probability of infection both at admission and last follow-up.

Link: Does everything that’s counted count?

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

2 comments

  • The very best prognosis method is still the very experienced care giver and not any known laboratory finding. I can simply observe, perhaps feel , and surely smell a wound and watch its progress without measuring protease levels, pH, know if the wound is ischemic, take a history and do a complete physical exam without spending a lot of money on tests. You do not get this from the various courses offered of from the steps to “board certification” by HMP supported testing. Clearly, if you do not spend the time to become an experienced bedside clinician , some of these tests may be helpful to you. First and foremost, get a great experienced mentor and become a great clinician who answers to science and the bedside and not to wound care company detail personal or the hired “experts” who have never treated a patient but make large financial personal gains by becoming the experts propped up at national meetings by company backers!

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