Fibrinogen: A Marker in Predicting Diabetic Foot Ulcer Severity

Abstract

Aims. To examine whether fibrinogen levels are a valuable biomarker for assessing disease severity and monitoring disease progression in patients with diabetic foot ulcer (DFU). Methods. A retrospective study was designed to examine the utility of fibrinogen in estimating disease severity in patients with DFU admitted to our hospital between January 2015 and January 2016. In total, 152 patients with DFU were enrolled in the study group, and 52 age and gender matched people with diabetes but no DFU were included as the control group. DFU severity was assessed using Wagner criteria. Results. Patients with DFU were divided into 2 subgroups based on the Wagner criteria. Mean fibrinogen values were significantly higher in patients with DFU grade ≧ 3 compared to those with DFU grades 1-2 (5.23 ± 1.37 g/L versus 3.61 ± 1.04 g/L). Using ROC statistic, a cut-off value of 5.13 g/L indicated the possible amputation with a sensitivity of 81.8% and a specificity of 78.9% (positive predictive value [PPV] 78.6%, negative predictive value [89.0%]). Fibrinogen values were found to be correlated with CRP levels, neutrophil, and WBC count. Conclusions. Fibrinogen levels might be a valuable tool for assessing the disease severity and monitoring the disease progression in patients with DFU.

The Role of Serum Procalcitonin, Interleukin-6, and Fibrinogen Levels in Differential Diagnosis of Diabetic Foot Ulcer Infection

“…The first one of these was the study performed by Weigelt et al [ 17 ], and it was shown that there was no significant difference between the patients with and without diabetic ulcer regarding serum fibrinogen levels. The second one of these was the study performed by Li et al [ 19 ], and serum fibrinogen levels were found to be associated with the severity of diabetic foot ulcer and undergoing amputation. In our study, serum fibrinogen levels were found to be effective for discriminating infected diabetic foot ulceration from uninfected diabetic foot ulceration.…”

“…The presence of purulent discharge or two or more findings of inflammation (erythema, local warmth, local tenderness, pain, and induration) in diabetic ulcer were considered to be evidence of infection. Discrimination of IDFU and NIDFU was performed according to Infectious Diseases Society of America guidelines [ 19 ]. The patients followed up with the diagnosis of type 2 diabetes mellitus and who had no diabetic foot ulcer were determined to be the control group.…”

“…Fibrinogen and fibrin play important roles in blood clotting, fibrinolysis, cellular and matrix interactions, inflammation, wound healing, and neoplasia [ 18 ]. It was reported that serum fibrinogen levels were increased as an acute-phase protein in diabetic ulcers [ 17 , 19 ].…”

Genome-wide association study identifies novel risk variants from RPS6KA1, CADPS, VARS, and DHX58 for fasting plasma glucose in Arab population

“…The presented results indicate that the DHX58 risk variant regulates DHX58, RAB5C, KCNH4, and HSPB9; interestingly, previous global GWAS implicated these four genes in CAD 17 . Furthermore, markers from RAB5C were associated with fibrinogen levels, which are known to be elevated in diabetic patients, especially those with foot ulcers 40 . Our results pointed to significant (p-value < 0.003) interactions between TG and (HOMA-IR and C-peptide levels) and between FPG and HOMA-β at genotypes homozygous for a risk allele.…”

Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review

“…Plain radiography, positron emission tomography (PET), MRI and leukocyte counting were other OCOMs used for the diagnosis of osteomyelitis. The OCOMs with the highest PPV (96%) and NPV (94%) in this subgroup were MRI and PET, respectively, but they require more time and resources than the probe-to-bone test [33,62]. LR+ and LR− have only been calculated for the probe-to-bone test, which gives more support for its use.…”