1526. The Role Of Inflammatory Markers: WBC, CRP, ESR, And Neutrophil-to-Lymphocyte Ratio (NLR) In The Diagnosis And Management Of Diabetic Foot Infections
Session: Poster Abstract Session: Clinical Infectious Diseases: Diabetic Foot Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: Diabetic foot infections (DFI) are frequently associated with increased morbidity, hospitalization, and amputations. To assess the severity of inflammation associated with DFI, we often measure the values of specific inflammatory markers like white blood count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR). It is well established that these markers are good indicators of inflammation, but it remains unclear if they can aid the clinician in the diagnosis and management of DFI, and ensure a more rational use of antibiotics. 

Methods: Our objective was to assess the utility of specific inflammatory markers (WBC, CRP, ESR and NLR) in discriminating between various stages of DFI. We performed a retrospective chart review of 380 adult patients admitted to Banner-University Medical Centers in Tucson AZ, between January 2013 and December 2013 for diabetic foot complications. The primary outcomes were a healed diabetic foot, a non-infected foot ulcer, an infected diabetic foot only involving soft tissue, and a diabetic foot infection involving bone (osteomyelitis).

 Results: There was no relationship between clinical diagnosis and CRP (P = 0.27), between clinical diagnosis and ESR (P = 0.15) or between clinical diagnosis and NLR at follow up (P = 0.15). However, there was significant relationship between clinical diagnosis and WBC at follow up (P = 0.045).

 Conclusion: Our study calls into question the utility of measuring and trending CRP, ESR, and NLR in patients with DFI. Instead, a cheaper and more accessible marker, WBC, is more useful in assessing the severity of the diabetic foot at follow up.

Eric Ong, MD1, Sumaya Farran, MD1, Michelle Salloum, N/A1, Summer Gardner, N/A1, Nicholas Giovinco, DPM2, David Armstrong, DPM MD PhD2, David Nix, PharmD3 and Mayar Al Mohajer, MD FACP1, (1)Department of Medicine, University of Arizona, Tucson, AZ, (2)Department of Surgery, University of Arizona, Tucson, AZ, (3)College of Pharmacy, University of Arizona, Tucson, AZ


E. Ong, None

S. Farran, None

M. Salloum, None

S. Gardner, None

N. Giovinco, None

D. Armstrong, None

D. Nix, None

M. Al Mohajer, None

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