TY - JOUR
T1 - Update of biomarkers to diagnose diabetic foot osteomyelitis
T2 - A meta-analysis and systematic review
AU - Ansert, Elizabeth A.
AU - Tarricone, Arthur N.
AU - Coye, Tyler L.
AU - Crisologo, Peter A.
AU - Truong, David
AU - Suludere, Mehmet A.
AU - Lavery, Lawrence A.
N1 - Publisher Copyright:
© 2024 The Authors. Wound Repair and Regeneration published by Wiley Periodicals LLC on behalf of The Wound Healing Society.
PY - 2024
Y1 - 2024
N2 - The aim of this study was to evaluate the diagnostic characteristics of biomarker for diabetic foot osteomyelitis (DFO). We searched PubMed, Scopus, Embase and Medline for studies who report serological markers and DFO before December 2022. Studies must include at least one of the following diagnostic parameters for biomarkers: area under the curve, sensitivities, specificities, positive predictive value, negative predictive value. Two authors evaluated quality using the Quality Assessment of Diagnostic Accuracy Studies tool. We included 19 papers. In this systematic review, there were 2854 subjects with 2134 (74.8%) of those patients being included in the meta-analysis. The most common biomarkers were erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin (PCT). A meta-analysis was then performed where data were evaluated with Forrest plots and receiver operating characteristic curves. The pooled sensitivity and specificity were 0.72 and 0.75 for PCT, 0.72 and 0.76 for CRP and 0.70 and 0.77 for ESR. Pooled area under the curves for ESR, CRP and PCT were 0.83, 0.77 and 0.71, respectfully. Average diagnostic odds ratios were 16.1 (range 3.6–55.4), 14.3 (range 2.7–48.7) and 6.7 (range 3.6–10.4) for ESR, CRP and PCT, respectfully. None of the biomarkers we evaluated could be rated as ‘outstanding’ to diagnose osteomyelitis. Based on the areas under the curve, ESR is an ‘excellent’ biomarker to detect osteomyelitis, and CRP and PCT are ‘acceptable’ biomarkers to diagnose osteomyelitis. Diagnostic odds ratios indicate that ESR, CRP and PCT are ‘good’ or ‘very good’ tools to identify osteomyelitis.
AB - The aim of this study was to evaluate the diagnostic characteristics of biomarker for diabetic foot osteomyelitis (DFO). We searched PubMed, Scopus, Embase and Medline for studies who report serological markers and DFO before December 2022. Studies must include at least one of the following diagnostic parameters for biomarkers: area under the curve, sensitivities, specificities, positive predictive value, negative predictive value. Two authors evaluated quality using the Quality Assessment of Diagnostic Accuracy Studies tool. We included 19 papers. In this systematic review, there were 2854 subjects with 2134 (74.8%) of those patients being included in the meta-analysis. The most common biomarkers were erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin (PCT). A meta-analysis was then performed where data were evaluated with Forrest plots and receiver operating characteristic curves. The pooled sensitivity and specificity were 0.72 and 0.75 for PCT, 0.72 and 0.76 for CRP and 0.70 and 0.77 for ESR. Pooled area under the curves for ESR, CRP and PCT were 0.83, 0.77 and 0.71, respectfully. Average diagnostic odds ratios were 16.1 (range 3.6–55.4), 14.3 (range 2.7–48.7) and 6.7 (range 3.6–10.4) for ESR, CRP and PCT, respectfully. None of the biomarkers we evaluated could be rated as ‘outstanding’ to diagnose osteomyelitis. Based on the areas under the curve, ESR is an ‘excellent’ biomarker to detect osteomyelitis, and CRP and PCT are ‘acceptable’ biomarkers to diagnose osteomyelitis. Diagnostic odds ratios indicate that ESR, CRP and PCT are ‘good’ or ‘very good’ tools to identify osteomyelitis.
KW - biomarkers
KW - diabetic foot infection
KW - diabetic foot osteomyelitis
KW - osteomyelitis
UR - http://www.scopus.com/inward/record.url?scp=85189907819&partnerID=8YFLogxK
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U2 - 10.1111/wrr.13174
DO - 10.1111/wrr.13174
M3 - Article
C2 - 38566503
AN - SCOPUS:85189907819
SN - 1067-1927
JO - Wound Repair and Regeneration
JF - Wound Repair and Regeneration
ER -