红细胞沉降率诊断严重肾功能损害的糖尿病足感染患者骨髓炎的准确性降低：一项回顾性横断面研究。

Decreased accuracy of erythrocyte sedimentation rate in diagnosing osteomyelitis in diabetic foot infection patients with severe renal impairment: A retrospective cross-sectional study.

机构信息

Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

出版信息

PLoS One. 2022 Mar 23;17(3):e0265769. doi: 10.1371/journal.pone.0265769. eCollection 2022.

DOI:10.1371/journal.pone.0265769

PMID:35320298

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8942204/

Abstract

BACKGROUND

Rapid diagnosis and treatment of diabetic foot osteomyelitis (DFO) could reduce the risk of amputation and death in patients with diabetic foot infection (DFI). Erythrocyte sedimentation rate (ESR) is considered the most useful serum inflammatory marker for the diagnosis of DFO. However, whether severe renal impairment (SRI) affects its diagnostic accuracy has not been reported previously.

OBJECTIVE

To investigate the accuracy of ESR in diagnosing DFO in DFI patients with and without SRI.

METHODS

This was a retrospective cross-sectional study. From the inpatient electronic medical record system, the investigators extracted demographic information, diagnostic information, and laboratory test results of patients with DFI who had been hospitalized in Longhua Hospital from January 1, 2016 to September 30, 2021. Logistic regression was performed to analyze the interaction between ESR and SRI with adjustment for potential confounders. The area under the curve (AUC), cutoff point, sensitivity, specificity, prevalence, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were analyzed by receiver operating characteristic (ROC) curve analysis and VassarStats.

RESULTS

A total of 364 DFI patients were included in the analysis. The logistic regression analysis results showed that elevated ESR increased the probability of diagnosing DFO (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.75-3.28; adjusted P < 0.001); SRI was not associated with the diagnosis of DFO (adjusted OR, 3.20; 95% CI, 0.40-25.32; adjusted P = 0.271), but it had an obstructive effect on the diagnosis of DFO by ESR (adjusted OR, 0.48; 95% CI, 0.23-0.99; adjusted P = 0.048). ROC analysis in DFI patients without SRI revealed that the AUC of ESR to diagnose DFO was 0.76 (95% CI, 0.71-0.81), with the cutoff value of 45 mm/h (sensitivity, 67.8%; specificity, 78.0%; prevalence, 44.7%; PPV, 71.3%; NPV, 75.0%; LR+, 3.08; LR-, 0.41). In contrast, in patients with SRI, the AUC of ESR to diagnose DFO was 0.57 (95% CI, 0.40-0.75), with the cutoff value of 42 mm/h (sensitivity, 95.0%; specificity, 29.2%; prevalence, 45.5%; PPV, 52.8%; NPV, 87.5%; LR+, 1.34; LR-, 0.17).

CONCLUSIONS

The accuracy of ESR in diagnosing DFO in DFI patients with SRI is reduced, and it may not have clinical diagnostic value in these patients.

摘要

背景

快速诊断和治疗糖尿病足骨髓炎（DFO）可以降低糖尿病足感染（DFI）患者截肢和死亡的风险。红细胞沉降率（ESR）被认为是诊断 DFO 最有用的血清炎症标志物。然而，严重肾功能不全（SRI）是否影响其诊断准确性尚未有报道。

目的

探讨 ESR 对合并和不合并 SRI 的 DFI 患者中 DFO 的诊断准确性。

方法

这是一项回顾性的横断面研究。研究人员从龙华医院的住院电子病历系统中提取了 2016 年 1 月 1 日至 2021 年 9 月 30 日期间住院的 DFI 患者的人口统计学信息、诊断信息和实验室检查结果。采用 logistic 回归分析，对潜在混杂因素进行调整后，分析 ESR 和 SRI 之间的交互作用。采用受试者工作特征（ROC）曲线分析和 VassarStats 分析曲线下面积（AUC）、截断值、灵敏度、特异性、患病率、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR+）和阴性似然比（LR-）。

结果

共纳入 364 例 DFI 患者进行分析。logistic 回归分析结果表明，ESR 升高增加了 DFO 的诊断概率（调整后的比值比[OR]，2.40；95%置信区间[CI]，1.75-3.28；调整后的 P < 0.001）；SRI 与 DFO 的诊断无相关性（调整后的 OR，3.20；95%CI，0.40-25.32；调整后的 P = 0.271），但它对 ESR 诊断 DFO 有阻塞作用（调整后的 OR，0.48；95%CI，0.23-0.99；调整后的 P = 0.048）。在不合并 SRI 的 DFI 患者中进行 ROC 分析显示，ESR 诊断 DFO 的 AUC 为 0.76（95%CI，0.71-0.81），截断值为 45mm/h（灵敏度，67.8%；特异性，78.0%；患病率，44.7%；PPV，71.3%；NPV，75.0%；LR+，3.08；LR-，0.41）。相比之下，在合并 SRI 的患者中，ESR 诊断 DFO 的 AUC 为 0.57（95%CI，0.40-0.75），截断值为 42mm/h（灵敏度，95.0%；特异性，29.2%；患病率，45.5%；PPV，52.8%；NPV，87.5%；LR+，1.34；LR-，0.17）。