The Role of Serum HMGB-1 Level in Differentiating the Soft-Tissue Infection From Diabetic Foot Osteomyelitis

The incidence of diabetic foot infections is increasing due to the rising number of persons with diabetes and the prolonged life expectancy. It is vital to differentiate soft-tissue infection (STI) from diabetic foot osteomyelitis (DFO), as treatment modalities and durations vary widely, but this can be challenging. We aimed to assess the blood concentration levels of the high mobility group box 1 protein (HMGB-1) in STI and DFO compared to healthy subjects, and to investigate whether this protein could contribute to differentiating STI from DFO.

Data from patients with suspected soft-tissue infection or diabetic foot osteomyelitis and healthy volunteers were prospectively recorded. Mean C-reactive protein, erythrocyte sedimentation rate, white blood cell, and HMGB-1 values in the groups were analyzed. Cut-off values of HMGB-1 between the three groups were also determined. A three-phase bone scintigraphy was accepted as the diagnostic method for differentiating STI and DFO.

A total of 92 volunteers, were included in the study. Group 1 comprised 28 healthy individuals who composed the control group. Group 2 comprised the 35 patients diagnosed with STI, and Group 3 comprised 29 patients diagnosed with DFO. The HMGB-1 was significantly higher in DFO. The sensitivity, specificity, and accuracy of HMGB-1 in differentiating between STI and DFO was 55%, 94%, and 77%, respectively.

We concluded that measurement of the serum HMGB-1 level could be an adjunctive test in the differential diagnosis of diabetic foot infections.