Haojie Sun,* Hao Heng,* Xuekui Liu, Houfa Geng, Jun Liang

Department of Endocrinology, Xuzhou Central Hospital, Xuzhou, Jiangsu, 221009, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jun Liang, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, 221000, People’s Republic of China, Email mwlj521@njmu.edu.cn Houfa Geng, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, 221000, People’s Republic of China, Email genghoufa@xzhmu.edu.cn

Objective: This study aims to assess the value of the Neutrophil CD64 (nCD64) index as a novel, rapid biomarker for the diagnosis of Diabetic foot osteomyelitis (DFO), with the goal of enhancing the accuracy of early detection.
Methods: A total of 142 hospitalized patients with type 2 diabetes complicated by diabetic foot infection were included. Participants were categorized into a Non-DFO group (84 cases) and a DFO group (58 cases) based on the presence or absence of osteomyelitis. The white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and the nCD64 index were compared between the two groups. Logistic regression analysis was performed to identify risk factors associated with DFO. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to evaluate the sensitivity and specificity of the nCD64 index in diagnosing DFO.
Results: The nCD64 index was significantly elevated in the DFO group compared to the Non-DFO group (P< 0.05). Logistic regression analysis indicated that the nCD64 index and ESR were independent risk factors for DFO (P < 0.05). The ROC-AUC analysis indicated that both the nCD64 index and ESR were associated with DFO. The nCD64 index exhibited superior predictive value compared to ESR (AUC: 0.895 vs 0.846). Specifically, the nCD64 index demonstrated the highest sensitivity at 96.6%, while ESR showed the highest specificity at 82.1%. When combined, the predictive value of the nCD64 index and ESR was optimal, with an AUC of 0.937, sensitivity of 86.2%, and specificity of 91.7%.
Conclusion: The nCD64 index may serve as an effective new biomarker for the early detection of DFO. The combination of the nCD64 index and ESR could further enhance diagnostic accuracy.

Keywords: diabetic foot, osteomyelitis, nCD64 index, erythrocyte sedimentation rate, early diagnosis