Is Procalcitonin An Effective Marker For Osteomyelitis?

One of the big problems in diabetes and the diabetic foot is distinguishing whether there is an active bone infection and subsequently ascertaining the severity of that bone infection. For the first part of that clinical conundrum, we have used a number of different lab values and other tools in the past.

A new study has tried to examine the use of different markers in the diagnosis and monitoring of osteomyelitis treatment in the diabetic foot.¹ The study, which was recently published in the International Wound Journal, focused on 35 patients either with or without osteomyelitis. The study authors assessed erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor alpha (TNFα), monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-1 alpha (MIP1α) at baseline after three and six weeks of standard therapy. The study notes that procalcitonin levels in the osteomyelitis group were significantly higher at baseline than in the group with no osteomyelitis. The authors pointed out that there were no significant differences in the other markers between the two groups.

If procalcitonin proves to be useful in larger scale studies, this might be a tool that we could employ on a more consistent basis. I say these results have to be repeated in larger studies because I think there are conflicting data in the literature on the utility of procalcitonin and other markers such as this.

I think the bottom line is that fusing an element of common sense with appropriate objective data and a good quality clinical exam is key in healing folks and ultimately keeping them moving through their world.

Reference

1. Van Asten SA, Nichols A, La Fontaine J, et al. The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis. Int Wound J. 2015; epub Dec. 3.