Todorova Ani S, Dimova Rumyana B, Chakarova Nevena Y, Serdarova Mina S, Grozeva Greta G, Georgiev Georgi K, Tankova Tsvetalina I
Medical University of Sofia, Sofia, Bulgaria.
Int J Low Extrem Wounds. 2023 Jun;22(2):353-359. doi: 10.1177/15347346211011849. Epub 2021 Apr 28.
The aim of this study is to compare the efficacy of procalcitonin (PCT) and high-sensitive C-reactive protein (hsCRP) as diagnostic biomarkers in patients with diabetes and mild-to-moderate diabetic foot infections. A total of 119 patients (102 with type 2 diabetes and 17 with type 1 diabetes), of mean age 60.29 ± 10.05 years, divided into 3 groups-diabetic foot ulcer (DFU) with active infection (IDFU group, n = 41), DFU without clinical signs of infection (non-IDFU group, n = 35), and a control group with diabetes without DFU (n = 43). Infection severity was graded according to the International Working Group on the Diabetic Foot guideline-non-IDFU group as Grade 1, IDFU group as Grade 2 (n = 22), and Grade 3 (n = 19). Serum hsCRP was assessed by the immunoturbidimetric method and PCT by the enzyme chemiluminescence immunoassay (ECLIA) method. Levels of white blood cells (WBC) were assessed using the Medonic hematology analyzer and erythrocyte sedimentation rate (ESR) by the Westergren method. Serum hsCRP, WBC count, and ESR were significantly higher in the IDFU group as compared to non-IDFU and control groups, whereas PCT levels did not differ between the groups. hsCRP presented with higher sensitivity (80%), specificity (79%), area under the curve (AUC) 0.856, in comparison to PCT (sensitivity 63%, specificity 62%, AUC 0.617) for the presence of IDFU, as well as in the Grade 3 subgroup (84% sensitivity and specificity, AUC 0.911). The combined model of both markers did not present with better accuracy than using hsCRP alone. In conclusion, hsCRP appears to be a better diagnostic biomarker than PCT in the diagnosis of moderate foot ulcer infection. Both markers fail to distinguish mild infection.
本研究旨在比较降钙素原（PCT）和高敏C反应蛋白（hsCRP）作为诊断生物标志物在糖尿病合并轻至中度糖尿病足感染患者中的疗效。共纳入119例患者（102例2型糖尿病患者和17例1型糖尿病患者），平均年龄60.29±10.05岁，分为3组：伴有活动性感染的糖尿病足溃疡（IDFU组，n = 41）、无感染临床体征的糖尿病足溃疡（非IDFU组，n = 35）和无糖尿病足溃疡的糖尿病对照组（n = 43）。根据国际糖尿病足工作组指南对感染严重程度进行分级——非IDFU组为1级，IDFU组为2级（n = 22）和3级（n = 19）。血清hsCRP采用免疫比浊法评估，PCT采用酶促化学发光免疫分析（ECLIA）法评估。白细胞（WBC）水平使用梅敦力血液分析仪评估，红细胞沉降率（ESR）采用魏氏法评估。与非IDFU组和对照组相比，IDFU组的血清hsCRP、WBC计数和ESR显著更高，而各组间PCT水平无差异。对于IDFU的存在，与PCT相比（敏感性63%，特异性62%，曲线下面积[AUC] 0.617），hsCRP具有更高的敏感性（80%）、特异性（79%）、曲线下面积（AUC）0.856，在3级亚组中也是如此（敏感性和特异性均为84%，AUC 0.911）。两种标志物的联合模型并未表现出比单独使用hsCRP更好的准确性。总之，在诊断中度足溃疡感染方面，hsCRP似乎是比PCT更好的诊断生物标志物。两种标志物均无法区分轻度感染。
