Procalcitonin levels and other biochemical parameters in patients with or without diabetic foot complications

Diagnosis of infection in diabetic foot ulcer (DFU) is not always simple. The analytic precision of procalcitonin (PCT) was evaluated to clarify the use of PCT for distinguish the presence of infection in DFU in comparison to other inflammatory markers.

This study comprised 88 subjects distributed into four groups: 16 nondiabetic healthy subjects (group control), 17 patients with type 2 diabetes mellitus without foot Complication (group DM), 25 patients with noninfected diabetic foot (group NIDF), and 30 patients with infected diabetic foot (group IDF). Fasting blood samples were taken for measurement of glucose, hemoglobin A1C, lipid profile, renal function, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) and its derivatives. Plasma PCT was determined using an enzyme-linked immunosorbent assay.

PCT, WBC, ESR, and neutrophils (NEU) were found significantly higher in IDF group than other groups. The receiver operating characteristic analysis showed that sensitivity, specificity, the best cutoff value, and the area under the curve were for ESR (100%, 93%, 31.5 mm/h, 1; P < 0.001), for PCT (87.5%, 86.7%, 66.55 pg/dl, 0.977; P < 0.001), for NEU (93.8%, 93.3%, 5.35, 0.957; P < 0.001) and for WBC (93.8%, 90%, 9.29 × 10⁹/L, 0.942; P < 0.001), respectively.

The outcomes of this study recommend that PCT can be an asymptomatic marker in the diagnosis of infection in DFU with higher Wagner grades in combination with different inflammatory markers.