Ha Eun Yeong, Park Il Rae, Chung Seung Min, Roh Young Nam, Park Chul Hyun, Kim Tae-Gon, Kim Woong, Moon Jun Sung
Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea.
Department of Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea.
J Clin Med. 2024 Apr 17;13(8):2311. doi: 10.3390/jcm13082311.
: Diabetic foot ulcers are one of the complications in patients with diabetes, which can be caused by infection, neuropathy, and blood vessel disorder. Among them, infection is the most common cause, and if it becomes worse, amputation may be necessary. So, it is important to detect and treat infections early, and determining indicators that can confirm infection is also important. Known infection markers include white blood cells (WBCs), the erythrocyte sediment rate (ESR), C-reactive protein (CRP), and procalcitonin, but they are not specific to diabetic foot ulcers. Presepsin, also known as soluble CD14, is known to be an early indicator of sepsis. Recent studies have reported that presepsin can be used as an early indicator of infection. This study investigated whether presepsin could be used as an early marker of severe infection in patients with diabetic foot ulcers. We retrospectively studied 73 patients who were treated for diabetic foot ulcerations from January 2021 to June 2023 at Yeungnam University Hospital. Out of a total of 73 patients, 46 patients underwent amputations with severe infections, and the WBC level, ESR, and CRP, procalcitonin, and presepsin levels were significantly higher in the group of patients who underwent amputations. The cutoff of presepsin, which can predict serious infections that need amputation, was 675 ng/mL. A regression analysis confirmed that presepsin, HbA1c, and osteomyelitis significantly increased the risk of severe infections requiring amputation. Presepsin will be available as an early predictor of patients with severe infections requiring amputations for diabetic foot ulcerations.
糖尿病足溃疡是糖尿病患者的并发症之一，可由感染、神经病变和血管紊乱引起。其中，感染是最常见的原因，若病情恶化，可能需要截肢。因此，早期检测和治疗感染很重要，确定能够确诊感染的指标也很重要。已知的感染标志物包括白细胞（WBC）、红细胞沉降率（ESR）、C反应蛋白（CRP）和降钙素原，但它们并非糖尿病足溃疡所特有。可溶性CD14，即前降钙素原，已知是脓毒症的早期指标。最近的研究报告称，前降钙素原可作为感染的早期指标。本研究调查了前降钙素原是否可作为糖尿病足溃疡患者严重感染的早期标志物。我们回顾性研究了2021年1月至2023年6月在岭南大学医院接受糖尿病足溃疡治疗的73例患者。在总共73例患者中，46例因严重感染接受了截肢手术，截肢患者组的白细胞水平、红细胞沉降率、C反应蛋白、降钙素原和前降钙素原水平显著更高。可预测需要截肢的严重感染的前降钙素原临界值为675 ng/mL。回归分析证实，前降钙素原、糖化血红蛋白（HbA1c）和骨髓炎显著增加了需要截肢的严重感染风险。前降钙素原将可作为糖尿病足溃疡需要截肢的严重感染患者的早期预测指标。
