SLR - May 2022 - Ethan Pais, DPM
Reference: Eren MA, Güneş AE, Ceylan MR, İncebıyık H, Aydın MS, Dusak A, Sabuncu T. Pilot Study of The Diagnostic Value of Crp:Albumin Ratio for Osteomyelitis in Patients with Diabetic Foot Ulcers. J Wound Care. 2022 Mar 1;31(Sup3):S25-S28. doi: 10.12968/jowc.2022.31.Sup3.S25. PMID: 35199563.Level of Evidence: Retrospective review series – Level IV
Scientific Literature Review
Reviewed By: Ethan Pais, DPM
Residency Program: New York College of Podiatric Medicine/Metropolitan Hospital Center – New York, NY
Podiatric Relevance: Podiatry physicians are often presented with diabetic patients with foot ulceration who may or may not have concomitant osteomyelitis. The diagnosis of osteomyelitis often determines whether a patient will need admission and if surgery is indicated. As podiatric physicians we have some imaging tools and lab values to make this determination, but often are met with a need to correlate clinically. Having another evidence based prognostic lab value to guide our decision making will lead to better patient care and fewer false negative and false positive errors in our patient workups for diabetic ulcerations associated with osteomyelitis.
Methods: ESR, WBC, CRP, and CRP:albumin ratio were compared in patients with type II diabetes with foot ulceration and no MRI evidence of osteomyelitis (n=47) and patients with type II diabetes with foot ulceration and positive MRI evidence of osteomyelitis (n=50).
Results: ESR, WBC, CRP and CRP:albumin ratio were all significantly higher and albumin level was significantly lower in patients with diabetic foot ulceration (DFU) with MRI evidence of osteomyelitis versus DFU without MRI evidence of osteomyelitis. A CRP:albumin ratio of 1.74 or above as a positive predictor of osteomyelitis with a 92 percent sensitivity and an 80.9 percent specificity.
Conclusions: Diabetic foot ulcerations are a major burden on the healthcare system. Diagnosing osteomyelitis in DFU routinely increases length of stay and need for amputation or other surgical intervention. With bone biopsy being the gold standard for diagnosis, podiatric physicians additionally use imaging and laboratory testing to determine the presence or absence of osteomyelitis. By having another prognostic indicator in our repertoire to accurately diagnose the presence of infection, podiatric physicians can improve accuracy in diagnosing osteomyelitis in DFU. Physicians should consider a CRP:albumin ratio of 1.74 or above as a positive predictor of osteomyelitis with a 92 percent sensitivity and an 80.9 percent specificity. This will have large benefit to the health system but needs to be verified further high quality, evidence based studies.