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Ha EY, Park IR, Chung SM, Roh YN, Park CH, Kim TG, Kim W, Moon JS. The Potential Role of Presepsin in Predicting Severe Infection in Patients with Diabetic Foot Ulcers. J Clin Med 2024; 13:2311. [PMID: 38673584 PMCID: PMC11051563 DOI: 10.3390/jcm13082311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: 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. Methods: We retrospectively studied 73 patients who were treated for diabetic foot ulcerations from January 2021 to June 2023 at Yeungnam University Hospital. Results: 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. Conclusions: Presepsin will be available as an early predictor of patients with severe infections requiring amputations for diabetic foot ulcerations.
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Affiliation(s)
- Eun Yeong Ha
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Il Rae Park
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Seung Min Chung
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Young Nam Roh
- Department of Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Tae-Gon Kim
- Department of Plastic Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Woong Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
| | - Jun Sung Moon
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (E.Y.H.); (I.R.P.); (S.M.C.); (W.K.)
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Du Y, Wang J, Fan W, Huang R, Wang H, Liu G. Preclinical study of diabetic foot ulcers: From pathogenesis to vivo/vitro models and clinical therapeutic transformation. Int Wound J 2023; 20:4394-4409. [PMID: 37438679 PMCID: PMC10681512 DOI: 10.1111/iwj.14311] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
Diabetic foot ulcer (DFU), a common intractable chronic complication of diabetes mellitus (DM), has a prevalence of up to 25%, with more than 17% of the affected patients at risk of amputation or even death. Vascular risk factors, including vascular stenosis or occlusion, dyslipidemia, impaired neurosensory and motor function, and skin infection caused by trauma, all increase the risk of DFU in patients with diabetes. Therefore, diabetic foot is not a single pathogenesis. Preclinical studies have contributed greatly to the pathogenesis determination and efficacy evaluation of DFU. Many therapeutic tools are currently being investigated using DFU animal models for effective clinical translation. However, preclinical animal models that completely mimic the pathogenesis of DFU remain unexplored. Therefore, in this review, the preparation methods and evaluation criteria of DFU animal models with three major pathological mechanisms: neuropathy, angiopathy and DFU infection were discussed in detail. And the advantages and disadvantages of various DFU animal models for clinical sign simulation. Furthermore, the current status of vitro models of DFU and some preclinical studies have been transformed into clinical treatment programs, such as medical dressings, growth factor therapy, 3D bioprinting and pre-vascularization, Traditional Chinese Medicine treatment. However, because of the complexity of the pathological mechanism of DFU, the clinical transformation of DFU model still faces many challenges. We need to further optimize the existing preclinical studies of DFU to provide an effective animal platform for the future study of pathophysiology and clinical treatment of DFU.
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Affiliation(s)
- Yuqing Du
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jie Wang
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
- Endocrinology departmentShanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Weijing Fan
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Renyan Huang
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Hongfei Wang
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Guobin Liu
- Department of Peripheral Vascular SurgeryInstitute of surgery of traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
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Coye TL, Suludere MA, Kang GE, Crisologo PA, Malone M, Rogers LC, Lavery LA. The infected diabetes-related foot: Comparison of erythrocyte sedementation rate/albumin and C-reactive protein/albumin ratios with erythrocyte sedimentation rate and C-reactive protein to differentiate bone and soft tissue infections. Wound Repair Regen 2023; 31:738-744. [PMID: 37843834 DOI: 10.1111/wrr.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
The objective of this study was to evaluate the effectiveness of C-reactive protein (CRP)/albumin, erythrocyte sedimentation rate (ESR)/albumin ratio, ESR, CRP and albumin to differentiate bone and soft tissue infection in persons with diabetes. We retrospectively evaluated 242 individuals admitted to hospital with diabetes-related foot infections (DFI). We categorised DFI cases as either bone (OM) or soft tissue infection based on bone culture and/or histology. We evaluated the diagnostic accuracy of CRP, ESR, albumin, CRP/albumin and ESR/albumin as biomarkers to diagnose OM in persons with diabetes. The median age was 53 years (74% male). There were 224 diabetes-related patients of which 125 had been diagnosed with osteomyelitis. The ESR/albumin and CRP/albumin ratios cut-points were >17.84 and >1.83, respectively. ESR/albumin and CRP/albumin ratios had similar diagnostic parameters: AUC (0.71, 0.71), sensitivity (70.0%, 57.0%), specificity (62.0%, 75.0%), positive predictive value (67.0%, 71.0%) and negative predictive value (66.0% and 71.0%). In contrast diagnostic efficiency of CRP and ESR were AUC 0.71 and 0.71, sensitivity (45.6%, 71.2%), specificity (85.5%, 60.7%), positive predictive value (70.0%, 65.9%) and negative predictive value (59.5%, 66.4%), respectively. When comparing area under the curves, the results showed that ESR/albumin was not significantly different to ESR alone (Delong test pvs ESR >0.1). Similarly, CRP/albumin was not significantly different to CRP alone (Delong test pvs CRP >0.1). In conclusion, ESR/albumin and CRP/albumin ratios provided comparable results as using ESR and CRP alone.
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Affiliation(s)
- Tyler L Coye
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mehmet A Suludere
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gu Eon Kang
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas, USA
| | - P Andrew Crisologo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew Malone
- Limb Preservation and Wound Research Academic Unit, Liverpool Hospital, Southwestern Sydney LHD, Sydney, Australia
| | - Lee C Rogers
- Depart6ment of Orthopedic Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Zhang WQ, Tang W, Hu SQ, Fu XL, Wu H, Shen WQ, Chen HL. Effect of matrix metalloproteinases on the healing of diabetic foot ulcer: A systematic review. J Tissue Viability 2023; 32:51-58. [PMID: 36513539 DOI: 10.1016/j.jtv.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/24/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aims to discuss the expression of matrix metalloproteinase in wound healing of diabetic foot ulcers and further summarize the strategies of targeted matrix metalloproteinase and its inhibitors in the treatment of diabetic foot ulcers. METHODS Following PRISMA-SCR guidelines, databases (PubMed, Home-PMC-NCBI, CINAHL, Web of Science) were systematically searched from inception to 19 June 2022. Newcastle-Ottawa Scale (NOS) was used to evaluate the bias risk of the included studies. RESULTS Eight studies are finally eligible for our systematic review. The combined data analysis of 8 studies showed that there were no significant difference in age(p = 0.110), duration of diabetes(p = 0.197), glycosylated hemoglobin content(p = 0.489), size(p = 0.133) and depth(p>0.05) of initial ulcer between the ulcer wound healing group and the non-healing group. MMP-1, 2, 8, 9, and TIMP-1, 2 affected the healing of DFUs. In the DFUs healing group, the concentrations of MMP (MMP-1, 2, 8, 9) decreased, and the concentration of TIMP-1 increased. CONCLUSION Our study showed that high levels of MMP-1, 2, 9 delayed the healing of diabetic foot ulcers, and high expression of MMP-8 in tissues improved wound healing. This study also summarized the effective intervention strategies for the treatment of diabetic foot ulcers.
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Affiliation(s)
| | - Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, China
| | - Hua Wu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China.
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Ioffe OY, Stetsenko OP, Kindzer SL, Kryvopustov MS, Tsiura YP, Prykhodko YS. APPLICATION OF PROBIOTIC ANTISEPSIS FOR PURULENT COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1295-1301. [PMID: 37364088 DOI: 10.36740/wlek202305225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To improve the results of surgical treatment of patients with type 2 diabetes and purulent-necrotic wounds by using probiotic antiseptics. PATIENTS AND METHODS Materials and methods: 66 patients with type 2 diabetes and purulent-necrotic complications took part in this study. Probiotic antiseptics were used for local treatment in the experimental group (n=31), and traditional antiseptics were used in the control group (n=35). The levels of pro-inflammatory markers in the blood (IL-6, TNF-a, CRP) were studied; microscopic material was taken to study the type of cytogram during bandaging, before wound treatment with antiseptics or debridement on admission to the hospital (1st day), on the 3rd day and on the 7th day. RESULTS Results: Analysis of dynamic changes in pro-inflammatory markers between the first and seventh days proved that only in the experimental group there was a statistically significant difference (IL-6 (Р=0.004), TNF-a (Р=0.001), CRP (Р=0.018)). Detection of regenerative-inflammatory and regenerative cytogram types on the 7th day in the experimental group had a statistically significant difference compared to the control group (p=0.002 and p<0.001, respectively). CONCLUSION Conclusions: the use of probiotic antisepsis accelerates wound healing in patients with type 2 diabetes and purulent-necrotic complications.
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Affiliation(s)
| | | | | | | | - Yuri P Tsiura
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
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Hu YJ, Song CS, Jiang N. Single nucleotide variations in the development of diabetic foot ulcer: A narrative review. World J Diabetes 2022; 13:1140-1153. [PMID: 36578869 PMCID: PMC9791576 DOI: 10.4239/wjd.v13.i12.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetes mellitus has become a global health problem, and the number of patients with diabetic foot ulcers (DFU) is rapidly increasing. Currently, DFU still poses great challenges to physicians, as the treatment is complex, with high risks of infection, recurrence, limb amputation, and even death. Therefore, a comprehensive understanding of DFU pathogenesis is of great importance. In this review, we summarized recent findings regarding the DFU development from the perspective of single-nucleotide variations (SNVs). Studies have shown that SNVs located in the genes encoding C-reactive protein, interleukin-6, tumor necrosis factor-alpha, stromal cell-derived factor-1, vascular endothelial growth factor, nuclear factor erythroid-2-related factor 2, sirtuin 1, intercellular adhesion molecule 1, monocyte chemoattractant protein-1, endothelial nitric oxide synthase, heat shock protein 70, hypoxia inducible factor 1 alpha, lysyl oxidase, intelectin 1, mitogen-activated protein kinase 14, toll-like receptors, osteoprotegerin, vitamin D receptor, and fibrinogen may be associated with the development of DFU. However, considering the limitations of the present investigations, future multi-center studies with larger sample sizes, as well as in-depth mechanistic research are warranted.
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Affiliation(s)
- Yan-Jun Hu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
| | - Chen-Sheng Song
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Rojas-Bonilla JM. Severe Diabetic Foot Infections without Systemic Inflammatory Response Syndrome. Prospective Validation of a New Category. Wound Repair Regen 2022; 30:553-559. [PMID: 35841393 DOI: 10.1111/wrr.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
We aimed to validate the prognostic value of subclassifying moderate diabetic foot infections into two categories: moderate and moderate/severe. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections. Moderate infections were subclassified after applying a previously published score. Variables associated with prognosis were: need for any amputation, major amputation, need for hospitalization, length of hospitalization, length of antibiotic therapy, reinfection rate and infection-related mortality. Infections were moderate in 111 cases (55.5%) and severe in 89 (44.5%). Osteomyelitis was diagnosed in 114 cases (57%), 73 moderate (36.5%) and 41 severe (20.5%). Patients with severe OM had a higher rate of amputations, major amputations, hospitalizations and need for antibiotic therapy, and a longer duration of antibiotics when compared with moderate OM. After applying the score, moderate infections were subclassified into 73 moderate cases (65.7%) and 38 moderate/severe cases (34.3%). Moderate/severe had a higher rate of amputations, major amputations, hospitalizations and need for antibiotics than moderate ones. No differences regarding prognosis were found between moderate/severe and severe infections with systemic inflammatory response syndrome. Moderate/severe diabetic foot infections, which could also be known as severe infections without systemic inflammatory response syndrome, should be recognized as a new subgroup. We propose to merge severe diabetic foot infections with and without systemic inflammatory response syndrome into a unique category due to its prognostic value. Furthermore, osteomyelitis should be added to both moderate and severe new categories of diabetic foot infections. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Javier Aragón-Sánchez
- Department of Surgery, Diabetic Foot Unit. La Paloma Hospital. Las Palmas de Gran Canaria., Spain
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