High serum C-reactive protein level predicts mortality in patients with stage 3 chronic kidney disease or higher and diabetic foot infections

Abstract

BackgroundDiabetic patients are predisposed to foot infections because of vascular insufficiency and peripheral neuropathy. Diabetic foot infection is a common cause of mortality and lower extremity amputations (LEAs) in patients with chronic kidney disease (CKD). We evaluated the risk factors for mortality and LEAs in patients with stage 3 CKD or higher with diabetic foot infections.MethodsWe retrospectively evaluated a cohort of 105 CKD patients with diabetic foot infections between July 1998 and December 2011. We reviewed their demographic characteristics and laboratory parameters to evaluate the risk factors for mortality and amputations at 24 weeks after diagnosis of a diabetic foot infection.ResultsThe mortality of the 105 enrolled CKD patients was 21% at 24 weeks after the diagnosis of a diabetic foot infection. Cox proportional regression analyses revealed that age 60 years or older [odds ratio (OR) 3.03, 95% confidence interval (CI) = 1.02-9.02, P = 0.047] and initial serum C-reactive protein (CRP) level ≥ 3 mg/dL (OR 3.97, 95% CI = 1.17-13.43, P = 0.027) were independent risk factors for mortality at 24 weeks. Twenty-four patients (23%) underwent LEAs. On Cox proportional regression analyses, peripheral vascular disease (OR=4.49, 95% CI=1.98–10.17, P=0.01) and cerebrovascular accident (OR 2.42, 95% CI=1.09–5.39, P=0.03) were independently associated with LEAs.ConclusionThis study showed that age and serum CRP level, were independent risk factors for mortality at 24 weeks in patients with stage 3–5 CKD with diabetic foot infections. Peripheral vascular disease and cerebrovascular accident were significantly associated with LEAs.

Usefulness of serum procalcitonin as a diagnostic biomarker of infection in children with chronic kidney disease

“…Several factors differed significantly in the proven group, and among these factors we found positive correlations between each of WBC and CRP with serum PCT. The WBC and CRP are well-known markers of infection and were positively correlated with PCT [56]. Our data favor the idea of combining PCT and CRP in order to increase the sensitivity and specificity of the tests.…”

Cutoff value of serum procalcitonin as a diagnostic biomarker of infection in end-stage renal disease patients

“…Several variables differed significantly in the iESRD group and correlations were found between WBC and CRP and serum PCT. WBC and CRP are known indices of infection and were positively correlated with PCT, whereas serum albumin, a known indicator of nutritional status, was negatively correlated with serum PCT [ 20 ]. The present study had some limitations.…”

Risk factors for mortality in patients with diabetic foot infections: a prospective cohort study

“…Older age was a risk factor for mortality on multivariable analysis. Increased mortality with age has been previously reported among patients with diabetic foot ulceration – after toe amputation for a diabetic foot – and in patients with DFI in the context of chronic kidney disease . Increased age‐related comorbidities may play a role, as may the recognised poorer outcomes after amputation in the elderly .…”

“…Increased mortality with age has been previously reported among patients with diabetic foot ulcerationafter toe amputation for a diabetic footand in patients with DFI in the context of chronic kidney disease. 14,20,21 Increased age-related comorbidities may play a role, as may the recognised poorer outcomes after amputation in the elderly. 21,22 In our study, only two (0.5%) patients had major amputation as their initial procedure, and only 11 (2.7%) had a previous major amputation, limiting any conclusion that may have been drawn regarding outcomes after previous or initial major amputation level.…”