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Role of procalcitonin in infected diabetic foot ulcer

      Highlights

      • PCT and CRP positively correlated with infection severity of diabetic foot ulcers.
      • PCT >0.59 ng/ml in IDFU may be associated with other systemic bacterial infection.
      • Other infectious diseases should be also considered, when PCT levels are elevated.

      Abstract

      Aims

      Procalcitonin (PCT) has been recently accepted as a marker for diagnosing infection. The aim of the present study was to determine whether PCT levels are associated with infection severity of diabetic foot ulcers and whether PCT levels would be helpful to differentiate infected diabetic foot ulcer (IDFU) from IDFU associated with other infectious diseases (IDFU + O).

      Methods

      We prospectively included 123 diabetic patients hospitalized for IDFU. Infection severity of diabetic foot ulcers was graded according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot clinical classification of diabetic foot infection. Chest radiograph, urinalysis, urine microscopy, urine culture, and blood cultures (if fever was present) were performed for all patients to diagnose other infectious diseases. Laboratory parameters were measured from blood venous samples.

      Results

      PCT (Spearman’s ρ = 0.338, P < 0.001) and C-reactive protein (Spearman’s ρ = 0.477, P < 0.001) levels were significantly associated with infection severity of diabetic foot ulcers. However, only PCT levels could differentiate patients with associated infectious diseases from patients with no concomitant infection (area under the receiver-operator characteristic curve 0.869, P < 0.0001; cut-off value 0.59; sensitivity 94.7; specificity 88.5).

      Conclusion

      PCT and CRP levels positively correlated with infection severity of diabetic foot ulcers and PCT levels > 0.59 ng/mL in patients with IDFU may be associated with other systemic bacterial infection.

      Keywords

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      References

        • Cavanagh P.R.
        • Lipsky B.A.
        • Bradbury A.W.
        • Botek G.
        Treatment for diabetic foot ulcers.
        Lancet. 2005; 366: 1725-1735
        • Singh N.
        • Armstrong D.G.
        • Lipsky B.A.
        Preventing foot ulcers in patients with diabetes.
        JAMA. 2005; 293: 217-228
        • Pecoraro R.E.
        • Reiber G.E.
        • Burgess E.M.
        Pathways to diabetic limb amputation. Basis for prevention.
        Diabetes Care. 1990; 13: 513-521
        • Mayfield J.A.
        • Reiber G.E.
        • Sanders L.J.
        Preventive foot care in people with diabetes.
        Diabetes Care. 1998; 21: 2161-2177
        • Shen C.J.
        • Wu M.S.
        • Lin K.H.
        The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis.
        Eur J Clin Microbiol Infect Dis. 2013; 32: 807-814
        • Armstrong D.G.
        • Perales T.A.
        • Murff R.T.
        Value of white blood cell count with differential in the acute diabetic foot infection.
        J Am Podiatr Med Assoc. 1996; 86: 224-227
        • Eneroth M.
        • Apelqvist J.
        • Stenstrom A.
        Clinical characteristics and outcome in 223 diabetic patients with deep foot infections.
        Foot Ankle Int. 1997; 18: 716-722
        • Simon L.
        • Gauvin F.
        • Amre D.K.
        Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis.
        Clin Infect Dis. 2004; 39: 206-217
        • Schuetz P.
        • Christ-Crain M.
        • Muller B.
        Biomarkers to improve diagnostic and prognostic accuracy in systemic infections.
        Curr Opin Crit Care. 2007; 13: 578-585
        • Stolz D.
        • Christ-Crain M.
        • Bingisser R.
        Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy.
        Chest. 2007; 131: 9-19
        • Uzun G.
        • Solmazgul E.
        • Curuksulu H.
        Procalcitonin as a diagnostic aid in diabetic foot infections.
        Tohoku J Exp Med. 2007; 213: 305-312
        • Jeandrot A.
        • Richard J.L.
        • Combescure C.
        Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study.
        Diabetologia. 2008; 51: 347-352
        • Massara M.
        • De Caridi G.
        • Serra R.
        The role of procalcitonin as a marker of diabetic foot ulcer infection.
        Int Wound J. 2015;
        • Mayfield J.A.
        • Reiber G.E.
        • Maynard C.
        • et al.
        The epidemiology of lower-extremity disease in veterans with diabetes.
        Diabetes Care. 2004; 27: B39-44
        • Williams D.T.
        • Hilton J.R.
        • Harding K.G.
        Diagnosing foot infection in diabetes.
        Clin Infect Dis. 2004; 39: S83-86
        • Saeed K.
        • Ahmad N.
        • Dryden M.
        The value of procalcitonin measurement in localized skin and skin structure infection, diabetic foot infections, septic arthritis and osteomyelitis.
        Expert Rev Mol Diagn. 2014; 14: 47-54
        • Lipsky B.A.
        d. International consensus group on, f. treating the infected diabetic, a report from the international consensus on diagnosing and treating the infected diabetic foot.
        Diabetes Metab Res Rev. 2004; 20: S68-77
        • Davies J.
        Procalcitonin.
        J Clin Pathol. 2015; 68: 675-679
        • Yo C.H.
        • Hsieh P.S.
        • Lee S.H.
        Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis.
        Ann Emerg Med. 2012; 60: 591-600
        • Linscheid P.
        • Seboek D.
        • Schaer D.J.
        Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes.
        Crit Care Med. 2004; 32: 1715-1721
        • Hatzistilianou M.
        Diagnostic and prognostic role of procalcitonin in infections.
        Sci World J. 2010; 10: 1941-1946
        • Henriquez-Camacho C.
        • Losa J.
        Biomarkers for sepsis.
        Biomed Res Int. 2014; 2014: 547818
        • Jonaidi Jafari N.
        • Safaee Firouzabadi M.
        • Izadi M.
        Can procalcitonin be an accurate diagnostic marker for the classification of diabetic foot ulcers?.
        Int J Endocrinol Metab. 2014; 12: e13376
        • Van Asten S.A.
        • Nichols A.
        • La Fontaine J.
        The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis.
        Int Wound J. 2015;
        • Mutluoglu M.
        • Uzun G.
        • Ipcioglu O.M.
        Can procalcitonin predict bone infection in people with diabetes with infected foot ulcers? A pilot study.
        Diabetes Res Clin Pract. 2011; 94: 53-56
        • Bolia R.
        • Srivastava A.
        • Marak R.
        Role of procalcitonin and C-reactive protein as biomarkers of infection in children with liver disease.
        J Pediatr Gastroenterol Nutr. 2016;
        • Hatherill M.
        • Tibby S.M.
        • Sykes K.
        Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count.
        Arch Dis Child. 1999; 81: 417-421
        • Rothenburger M.
        • Markewitz A.
        • Lenz T.
        Detection of acute phase response and infection. The role of procalcitonin and C-reactive protein.
        Clin Chem Lab Med. 1999; 37: 275-279
        • Hung S.Y.
        • Huang Y.Y.
        • Hsu L.A.
        Treatment for diabetic foot ulcers complicated by major cardiac events.
        Can J Diabetes. 2015; 39: 183-187
        • Christ-Crain M.
        • Muller B.
        Procalcitonin in bacterial infections–hype, hope, more or less?.
        Swiss Med Wkly. 2005; 135: 451-460
        • Hausfater P.
        • Garric S.
        • Ayed S.B.
        Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study.
        Clin Infect Dis. 2002; 34: 895-901
        • Charles P.E.
        • Ladoire S.
        • Aho S.
        Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.
        BMC Infect Dis. 2008; 8: 38
        • Maier M.
        • Wutzler S.
        • Lehnert M.
        Serum procalcitonin levels in patients with multiple injuries including visceral trauma.
        J Trauma. 2009; 66: 243-249
        • Okada Y.
        • Minakami H.
        • Tomomasa T.
        Serum procalcitonin concentration in patients with Kawasaki disease.
        J Infect. 2004; 48: 199-205
        • Chen D.Y.
        • Chen Y.M.
        • Ho W.L.
        Diagnostic value of procalcitonin for differentiation between bacterial infection and non-infectious inflammation in febrile patients with active adult-onset Still's disease.
        Ann Rheum Dis. 2009; 68: 1074-1075
        • Harrison M.
        • Collins C.D.
        Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis?.
        Infect Control Hosp Epidemiol. 2015; 36: 265-272
        • Deliberato R.O.
        • Marra A.R.
        • Sanches P.R.
        Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting.
        Diagn Microbiol Infect Dis. 2013; 76: 266-271
        • Schuetz P.
        • Balk R.
        • Briel M.
        Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective.
        Clin Chem Lab Med. 2015; 53: 583-592