Omar J, Ahmad N S, Che-Soh Naa, Wan-Azman W N, Yaacob N M, Abdul-Ghani N S, Abdullah M R
Department of Chemical Pathology, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Department of Pathology, Hospital Bintulu Sarawak, Bintulu, Malaysia.
Malays Orthop J. 2023 Jul;17(2):62-69. doi: 10.5704/MOJ.2307.010.
Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU).
This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and C-reactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification.
The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL.
PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.
感染性糖尿病足溃疡若在早期未被识别，可能会导致严重并发症。在该阶段，感染的诊断极具挑战性；因此，一种敏感的炎症生物标志物可能会有所帮助。我们旨在评估降钙素原（PCT）作为感染性糖尿病足溃疡（IDFU）早期生物标志物的作用。
本横断面研究于2020年5月至2020年12月在马来西亚理科大学医院（USM）的家庭医疗诊所（KRK）、骨科诊所及病房进行。共招募了264名参与者，分为三组：50名无溃疡的糖尿病患者（对照组）、107名非感染性糖尿病足溃疡（NIDFU）患者和107名感染性糖尿病足溃疡（IDFU）患者。对所有患者检测PCT水平。仅对IDFU患者检测白细胞总数（TWC）和C反应蛋白（CRP）。感染的诊断依据美国传染病学会-糖尿病足国际工作组（IDSA-IMWGDF）标准，感染严重程度根据瓦格纳分类法分级。
IDFU患者的PCT水平高于NIDFU患者和糖尿病患者，中位数（IQR）分别为0.355（0.63）ng/mL、0.077（0.15）ng/mL和0.028（0.02）ng/mL。在IDFU患者中，PCT与CRP呈中度正相关（p<0.001）。在最佳截断值为0.25 ng/mL时，敏感性和特异性分别为63.6%和83.2%。
PCT是诊断感染的有价值生物标志物；然而，鉴于其低敏感性，在IDFU的早期诊断中价值不大。
