title: The Role of Biomarkers to Diagnose Diabetic Foot Osteomyelitis. A Meta-analysis.
abstract: OBJECTIVE
  To systematically review the value of serum inflammatory markers to diagnose diabetic foot osteomyelitis (DFO).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas, USA. suzanne.vanasten@utsouthwestern.edu.
authors.forename: Suzanne Aura
authors.initials: SA
authors.lastname: Victoria van Asten
authors.forename: Edgar Joseph
authors.initials: EJ
authors.lastname: Geradus Peters
authors.forename: Yin
authors.initials: Y
authors.lastname: Xi
authors.forename: Lawrence Alfred
authors.initials: LA
authors.lastname: Lavery
mesh_terms: D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D017719:Diabetic Foot / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D010019:Osteomyelitis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D002116:Calcitonin; D002097:C-Reactive Protein