당뇨발 감염진단을 위한 WBC, ESR, CRP의 유용성 비교

Abstract

Purpose: Diagnosis of diabetic foot infection is sometimes difficult, since the classical inflammatory signs and leukocytosis may be absent due to the decreased host immune response in diabetics. Therefore inflammatory blood markers, such as white blood cell(WBC) count, erythrocyte sedimentation rate(ESR), and C-reactive protein(CRP) have been commonly needed to confirm the diagnosis of infection. The purpose of this study is to evaluate the diagnostic usefulness of WBC, ESR and CRP for detection of diabetic foot infection. Methods: Peripheral blood samples were taken from 113 patients with diabetic foot ulcers admitted from June 2007 to April 2009. Diabetic foot infection was diagnosed according to the microbiological culture from soft tissue and bone specimens. Reference values of tests were 4500- 11000/μL for WBC count, 0-20mm/hr for ESR, and 0-5 mg/L for CRP13,14. Sensitivities, specificities, positive and negative predictive values of laboratory tests were calculated and analysed. Receiver-operator characteristic (ROC) curve was also created.

Received March 9, 2010Revised April 5, 2010Accepted June 10, 2010Address Correspondence: Seung-Kyu Han, M.D., Department of Plastic Surgery, Korea University Guro Hospital, 97 Guro- dong, Guro-gu, Seoul 152-703, Korea. Tel: 02) 2626-3333/ Fax: 02) 868-6698/ E-mail: pshan@kumc.or.kr Results: There was a significant difference in WBC, ESR, and CRP between infectious group and noninfectious group(p＜0.05). The sensitivity of WBC＞11,000/μL ESR ＞20 mm/hr, and CRP > 5mg/L was 30%, 96%, and 84%. The specificity was 86%, 14%, and 50% for WBC, ESR, and CRP, respectively. Positive predictive value was 88%, 78%, and 84%, and negative predictive value was 28%, 50%, and 50% respectively. The areas under the ROC curve for WBC, ESR and CRP were 0.72, 0.75, and 0.78 respectively. Conclusion: Based on the results of this study, we conclude that CRP is more useful method in predicting and diagnosing infection than WBC, ESR in diabetic foot ulcer patients.