Pentraxin‐3: A new parameter in predicting the severity of diabetic foot infection?

Abstract

This study was undertaken to evaluate the diagnostic and prognostic values of pentraxin‐3 (PTX‐3) in patients with infected diabetic foot ulcers (IDFU) as well as to assess the association between PTX‐3 levels and IDFU severity. This study included 60 IDFU patients (Group 1), 45 diabetic patients without DFU (Group 2), and 45 healthy controls. Patients with IDFU were divided into mild, moderate, and severe subgroups based on classification of clinical severity. Patients who underwent amputation were also documented. Blood samples were collected to determine PTX‐3 levels. PTX‐3 levels in healthy controls, Group 1, and Group 2 were 5.83 (3.41‐20) ng/mL, 1.47 (0.61‐15.13) ng/mL, and 3.26 (0.67‐20) ng/mL, respectively. A negative correlation between plasma PTX‐3 and glucose levels was found. There were significant differences in terms of procalcitonin (PCT) and PTX‐3 levels in the subgroup analysis of Group 1. The PTX‐3 level in patients who did or did not undergo amputation was 4.1 (0.8‐13.7) and 1 (0.6‐15.1) ng/mL, respectively. Results suggest that PTX‐3 is a particularly effective marker in patients with IDFU, both in terms of predicting disease severity and assisting in the decision to perform amputation.

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

“…Two prospective cohort studies have validated all or part of the IWGDF/IDSA DFI classification, and one prospective and four retrospective cohort studies have validated the IWGDF/IDSA as part of a larger diabetic foot classification system. These and other studies from around the world have provided some evidence that increasing severity of infection is associated with higher levels of inflammatory markers, a greater likelihood of the patient being hospitalised for treatment, longer duration of hospital stay, greater likelihood and higher level of lower extremity amputation, and higher rate of readmission . Sepsis is uncommonly reported (perhaps partly being unrecognized) in patients with a DFI, even in the presence of extensive local signs and symptoms of infection.…”

“…There are several diagnostic methods against which clinical examinations could be compared to evaluate their ability to assess the presence or severity of foot infection or to differentiate soft tissue from bone infection. Most available studies assessed the value of blood tests, especially white blood cell (WBC) counts, ESR, CRP, and PCT, by comparing them with the results of IDSA/IWGDF criteria for infection . Unfortunately, the severity of infection in patients included in the available studies was not always clearly defined, which may account for interstudy differences in findings.…”

“…Serum tests for these common biomarkers are widely available, easily obtained, and most are relatively inexpensive. A few studies investigated other inflammatory markers for their role in diagnosing or following DFIs, but they were small and of low quality …”

“…In PCT, by comparing them with the results of IDSA/IWGDF criteria for infection. 9,42,54 Unfortunately, the severity of infection in patients included in the available studies was not always clearly defined, which may account for interstudy differences in findings. In addition, many studies do not specify if enrolled patients were recently treated with antibiotic therapy, which could affect results.…”

Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)

“…acidosis, hyperglycemia, dyslipidemia, electrolyte disturbances, worsening azotemia). Clinical findings include leukocytosis, left-band shift, elevated inflammatory markers (such as ESR and CRP) and elevated procalcitonin, all of which elaborate the possibility of deep tissue infection [ 11 ]. The latest IWGDF guidelines discuss the role of inflammatory serum biomarkers in diagnosing DFI.…”