The Role of Biomarkers to Diagnose Diabetic Foot Osteomyelitis. A Meta-analysis

Purpose: To systematically review the value of serum inflammatory markers to diagnose diabetic foot osteomyelitis (DFO). Study selection: Studies to diagnose DFO using biomarkers erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukins (IL-2, IL-6, IL-8) and tumor necrosis factor alfa (TNF) were retrieved from EMBASE and PubMed with no language restrictions through July 2014. Data extraction: We summarized clinical characteristics of the studies and used bivariate random effects models and summary receiver operating characteristic curves to estimate sensitivity and specificity for each marker. Data synthesis: A total of 8 qualifying studies were included in our meta-analysis. Bivariate pooled sensitivity and specificity of the 6 studies examining ESR were 0.81 (95% CI 0.71-0.88) and 0.90 (95% CI 0.75-0.96) respectively. Due to the paucity of data, models did not converge for the other biomarkers. Conclusions: From the inflammatory markers, ESR appears to be the best laboratory test to identify patients with DFO. Keywords: Diabetic foot, osteomyelitis, biomarkers, diabetic foot infection, diagnosis, erythrocyte sedimentation rate, c-reactive protein, procalcitonin.