Is procalcitonin superior to CRP and ESR in the diagnosis of diabetic foot osteomyelitis? A systematic review and meta-analysis

BACKGROUND: In this study, we aimed to assess the diagnostic accuracy of inflammatory biomarkers in clinical practice to distinguish diabetic foot osteomyelitis (DFO) from soft tissue infection in diabetes. METHODS: Electronic databases were searched for relevant studies on the diagnosis of DFO using CRP, ESR, or PCT until Sep 2023. We pooled sensitivity, specificity, PLR, NLR, DOR, and ROC-AUC to assess the diagnostic value of biomarkers for DFO. We evaluated the included study with the QUADAS tool. The sensitivity analysis and publication bias were assessed. RESULTS: A total of 14 studies with 1698 patients were included in this meta-analysis. The combined sensitivity was 0.78 (95% CI: 0.66–0.87), specificity was 0.72 (95% CI: 0.64–0.78), and AUC was 0.79 for CRP diagnosis. The combined sensitivity was 0.77 (95% CI: 0.67–0.85), specificity was 0.74 (95% CI: 0.65–0.81), and AUC was 0.82 for ESR diagnosis. The combined sensitivity was 0.88 (95% CI: 0.63–0.97), specificity was 0.81 (95% CI: 0.63–0.92), and AUC was 0.91 for PCT. CONCLUSION: This study evaluated the role of ESR, CRP, and PCT in the diagnosis of DFO, and found that PCT had the best diagnostic test accuracy in distinguishing DFO from soft tissue infection in diabetes. CLINICAL TRIAL: Not applicable.