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The Egyptian Journal of Internal Medicine
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Procalcitonin as a marker of diabetic foot ulcer infection

The Egyptian Journal of Internal Medicine volume 31, pages 652–657 (2019)Cite this article

Abstract

Background

Procalcitonin (PCT), an amino acid protein precursor of calcitonin hormone released by thyroid C cells or other body cells, can be used as a marker for diagnosing infection. PCT has a suggestive role in diagnosing diabetic foot infection alone or in combination with other markers of infection.

Objective

The aim was to clarify the effectiveness of PCT as a marker for diagnosing of infection in Egyptian patients with diabetic foot ulcer (DFU) in comparison with other inflammatory markers such as C-reactive protein, white blood cell count, and erythrocyte sedimentation rate.

Patients and methods

This cross-sectional study was carried out at Menoufia University Hospitals, from the period of January 2018 to December 2018. In total, 90 patients were classified into three groups; each group contained 30 patients: group I served as diabetic control without foot ulcers, group II patients had noninfected DFU, and group III patients had infected diabetic foot ulcer (IDFU). Diagnosis of IDFU relied on Infectious Diseases Society of America-International Working Group on the Diabetic Foot classification of diabetic foot infection.

Results

Serum PCT levels were elevated in DFU groups, with significantly higher in infected more than noninfected DFU. In addition, PCT levels were significantly higher in patients with IDFU compared with traditional markers such as C-reactive protein, erythrocyte sedimentation rate, and white blood cell counts.

Conclusion

Based on our results, we conclude that PCT has a valuable role in diagnosing infection in DFUs.

References

  1. Pemayun TG, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle 2015; 6:29629.

    Article  Google Scholar 

  2. Suckow BD, Goodney PP, Nolan BW, Veeraswamy RK, Gallagher P, Cronenwett JL, et al. Domains that determine quality of life in vascular amputees. Ann Vasc Surg 2015; 29:722–730.

    Article  Google Scholar 

  3. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54: e132–e173.

    Article  Google Scholar 

  4. Monteiro-Soares M, Martins-Mendes D, Vaz-Carneiro A, Sampaio S, Dinis-Ribeiro M. Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis. Diabetes Metab Res Rev 2014; 30:610–622.

    Article  CAS  Google Scholar 

  5. Abbas M, Uckay I, Lipsky BA. In diabetic foot infections antibiotics are to treat infection, not to heal wounds. Expert Opin Pharmacother 2015; 16:821–832.

    Article  CAS  Google Scholar 

  6. Singh S, Pai DR, Yuhhui C. Diabetic foot ulcer – diagnosis and management. Clin Res Foot Ankle 2013; 1:120.

    Google Scholar 

  7. Saleem SM, Khan SS, Jan SS. Role of serum procalcitonin level in early diagnosis of bacterial pneumonia in children, a hospital-based study. Int J Res Med Sci 2016; 4:1518–1521.

    Article  Google Scholar 

  8. Oberhoffer M, Stonans I, Russwurm S, Stonane E, Vogelsang H, Junker U, et al. Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis-related cytokines in vitro. J Lab Clin Med 1999; 134:49–55.

    Article  CAS  Google Scholar 

  9. Velissaris D, Pantzaris ND, Platanaki C, Antonopoulou N, Gogos C. Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review. Rom J Intern Med 2018; 56:3–8.

    PubMed  Google Scholar 

  10. Jafari NJ, Firouzabadi MS, Izadi M, Firouzabadi MS, Saburi A. Can procalcitonin be an accurate diagnostic marker for the classification of diabetic foot ulcers?. Int J Endocrinol Metab 2014; 12:e13376.

    Google Scholar 

  11. Uzun G, Solmazgul E, Curuksulu H, Turhan V, Ardic N, Top C, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 2007; 213:305–312.

    Article  CAS  Google Scholar 

  12. Jeandrot A, Richard JL, Combescure C, Jourdan N, Finge S, Rodier M, et al. 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.

    Article  CAS  Google Scholar 

  13. Gary Sibbald R, Woo KY. The biology of chronic foot ulcers in persons with diabetes. Diabetes Metab Res Rev 2008; 24 (S1):S25–S30.

    Article  Google Scholar 

  14. Noor S, Zubair M, Ahmad J. Diabetic foot ulcer – a review on pathophysiology, classification and microbial etiology. Diabetes Metab Syndr 2015; 9:192–199.

    Article  Google Scholar 

  15. Massara M, De Caridi G, Serra R, Barillà D, Cutrupi A, Volpe A, et al. The role of procalcitonin as a marker of diabetic foot ulcer infection. Int Wound J 2017; 14:31–34.

    Article  Google Scholar 

  16. Christ-Crain M, Muller BE. Procalcitonin in bacterial infections-hype, hope, more or less?. Swiss Med Wkly 2005; 135:451–460.

    CAS  PubMed  Google Scholar 

  17. Park JH, Suh DH, Kim HJ, Lee YI, Kwak IH, Choi GW. Role of procalcitonin in infected diabetic foot ulcer. Diabetes Res Clin Pract 2017; 128:51–57.

    Article  CAS  Google Scholar 

  18. Umapathy D, Dornadula S, Rajagopalan A, Murthy N, Mariappanadar V, Kesavan R, et al. Potential of circulatory procalcitonin as a biomarker reflecting inflammation among South Indian diabetic foot ulcers. J Vasc Surg 2018; 67:1283–1291.

    Article  Google Scholar 

  19. Rothenburger M, Markewitz A, Lenz T, Kaulbach HG, Marohl K, Kuhlmann WD, et al. Detection of acute phase response and infection. The role of procalcitonin and C-reactive protein. Clin Chem Lab Med 1999; 37:275–279.

    CAS  PubMed  Google Scholar 

  20. Karakas A, Arslan E, Cakmak T, Aydin I, Akgul EO, Demirbas S. Predictive value of soluble CD14, interleukin-6 and procalcitonin for lower extremity amputation in people with diabetes with foot ulcers: a pilot study. Pak J Med Sci 2014; 30:578–582.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, 32511, Egypt

    Nabil A. El-Kafrawy, Mohammed A. Shaaban, Mohammed A. Korany & Moustafa B. Ata MSc

  2. Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt

    Ahmed A. Sonbol

Authors
  1. Nabil A. El-Kafrawy
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  2. Mohammed A. Shaaban
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  3. Mohammed A. Korany
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  4. Ahmed A. Sonbol
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  5. Moustafa B. Ata MSc
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Correspondence to Moustafa B. Ata MSc.

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El-Kafrawy, N.A., Shaaban, M.A., Korany, M.A. et al. Procalcitonin as a marker of diabetic foot ulcer infection. Egypt J Intern Med 31, 652–657 (2019). https://doi.org/10.4103/ejim.ejim_29_19

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