The Role of Inflammatory Markers: WBC, CRP, ESR, and Neutrophil-to-Lymphocyte Ratio (NLR) in the Diagnosis and Management of Diabetic Foot Infections

Ong, Eric; Farran, Sumaya; Salloum, Michelle; Gardner, S.; Giovinco, Nicholas A.; Armstrong, David; Nix, David E.; Mohajer, Mayar Al

doi:10.1093/ofid/ofv133.1079

Cited by 5 publications

(4 citation statements)

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“…The median age of the current COVID-19 patients was 57 years and this may explain the positive correlation between sHLA-G and age, especially if we take into account the observations that SARS-CoV-2 can induce the expression of sHLA-G and also disproportionally affect the elderly [19] , [21] . With regard to WBC and ESR, the results may be justified because both are biomarkers of inflammation [43] , and sHLA-G molecules are involved in modulating inflammatory responses [13] . In the case of RBG, it has been demonstrated that sHLA-G was more frequent in patients with type 2 diabetes mellitus or impaired glucose tolerance than in normal glucose tolerance.…”

Section: Discussionmentioning

confidence: 99%

Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Al-Bayatee

Ad’hiah

2021

Human Immunology

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Soluble HLA-G (sHLA-G) molecules are considered potent immunomodulators, and their dysregulated expression has been implicated in several pathological conditions, including coronavirus disease 19 (COVID-19). Therefore, a case-control study (103 COVID-19 patients and 105 controls) was performed to determine sHLA-G role in severity of COVID-19. Results revealed that median levels of sHLA-G were significantly increased in serum of patients compared to controls (19.3 vs . 12.7 ng/mL; p < 0.001). When patients and controls were stratified by age group, gender, body mass index, chronic disease, or ABO and Rh blood groups, the sHLA-G level did not show a significant difference in each stratum. Logistic regression analysis demonstrated that the up-regulated expression of sHLA-G was associated with an elevated risk of developing COVID-19. Receiver operating characteristic curve analysis showed that sHLA-G was a very good predictor of COVID-19, and at a cut-off value of 15.4 ng/mL, the sensitivity and specificity of sHLA-G were 79.6 and 79.0%, respectively. Spearman rank correlation analysis revealed that sHLA-G was positively correlated with age, erythrocyte sedimentation rate, white blood cell count, and random blood glucose, while a negative correlation was recorded with vitamin D. In conclusion, up-regulated expression of sHLA-G was indicated in patients with severe COVID-19.

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Section: Discussionmentioning

confidence: 99%

Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Al-Bayatee

Ad’hiah

2021

Human Immunology

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“…Interestingly, cAMP has been shown to inhibit histamine release from human mast cells (Barreiro-Costa et al, 2014) and is reported to be key in several endogenous processes involved in preventing acute in ammation from progressing to deleterious chronic in ammation (Moore & Willoughby, 1995). Indeed, HFE reduced WBC and ESR (Table 3), both of which may be used as markers of in ammation status (Carr et al, n.d.;Farhangi et al, 2013;Harrison, 2015;Ingelsson et al, 2005;Kounis et al, 2014;Ong et al, 2015;Watson et al, 2012). Taken together, the data strongly support that HFE has anti-oedematogenic, anti-histaminic, anti-in ammatory, and immunomodulatory activities.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic or therapeutic administration of Holarrhena floribunda hydro ethanol extract suppresses Complete Freund’s Adjuvant-induced arthritis in Sprague-Dawley rats    

Antwi¹,

Oduro-Mensah

Obiri

et al. 2020

Preprint

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Ethnopharmacological relevance In Ghanaian folk medicine, Holarrhena floribunda has anecdotal use for the treatment of inflammatory conditions. A hydro ethanol extract of the stem bark has previously been shown to be effective in the management of acute inflammation and anaphylaxis in rodents.Aim of the study This study was aimed at evaluating the usefulness of H. floribunda stem bark hydro ethanol extract (HFE) for the management of chronic inflammation in a murine model.Materials and Methods Anti-arthritic effect of the extract was evaluated using Complete Freund’s Adjuvant-induced arthritis in male Sprague-Dawley rats. Using both prophylactic and therapeutic treatment models, parameters assessed included oedema, serology of inflammatory response, radiology, bone tissue histology and haematology. Data were analysed by ANOVA followed by Tukey’s multiple comparisons post hoc test.Results HFE at 50–500 mg/kg dose-dependently [P ≥ 0.0354 (prophylactic) and P ≥ 0.0001 (therapeutic)] inhibited swelling of the injected paw upon prophylactic [≤ 81.26 % (P < 0.0001)] or therapeutic [≤ 67.92 % (P < 0.01)] administration — and prevented spread of arthritis to the contralateral paw. Inflammation alleviation activity of HFE was further demonstrated by decrease in arthritis score, radiologic score and erythrocyte sedimentation rate. HFE at all doses significantly reduced serum IL-1α (P < 0.0197), and 500 mg/kg HFE reduced serum IL-6 (P = 0.0032). In contrast, serum concentrations of IL-10, protein kinase A and cyclic adenosine monophosphate were enhanced (P ≤ 0.0436). HFE consistently showed better prophylactic activity than when administered therapeutically.Conclusions The data demonstrate that HFE suppresses CFA-induced arthritis and modulates regulators of inflammation; including IL-1α, -6 and -10 which also play mediatory roles in several immune response pathways. These make HFE a strong candidate for development as an agent for management and modulation of inflammation and the inflammatory response, including immune response-related adverse events such as seen in severe COVID-19.

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“…CRP, ESR and NLR were reported to have no diagnostic value in patients with diabetic foot infection, whereas the less costly and more accessible marker WBC count was found to be more useful during follow-up for the evaluation of diabetes-related foot wound severity 18 . However, in another study, it was emphasised that leukocytosis is a poor marker of diabetic foot osteomyelitis because WBC count is normal in 50% of patients with osteomyelitis and high WBC count may be associated with soft tissue or systemic infection 47 .…”

Section: Patient Characteristicsmentioning

confidence: 98%

“…Many recent studies have investigated the use of serological markers such as C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), platelet/lymphocyte ratio, and neutrophil/lymphocyte ratio (NLR) in the diagnosis and treatment follow-up of osteomyelitis [17][18][19] . These parameters can be measured from patient blood and serum samples at a much lower cost compared to other methods or can be easily calculated from measured parameters.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of osteomyelitis in diabetic foot ulcers with exposed bone

Derebaşınlıoğlu¹,

Aksoy²

2023

WPR

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Purpose Exposed bone and periosteal damage promote the adherence of pathogens to bone matrix components. Damage to the periosteum adversely affects bone perfusion and creates a more suitable environment for pathogens. The purpose of this study was to determine the prevalence of osteomyelitis among patients with diabetic foot ulcers with bone exposure and to identify the role of simple serological markers in the diagnosis of osteomyelitis in this patient group.Methods Patients who underwent amputation and debridement due to diabetes-related foot wound were included in the study. The pathology results were evaluated according to presence of osteomyelitis. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), complete blood count (CBC), platelet/lymphocyte ratio, neutrophil/lymphocyte ratio (NLR) and microbial growth were analysed.Results Patients with ESR of 79mm/h or lower had a 3.046-fold higher risk of osteomyelitis. The risk of osteomyelitis was 2.901-fold higher at lymphocyte percentages of 12.3% or higher. Patients with a neutrophil percentage of 78% or lower had a 3.010-fold higher risk of osteomyelitis. Patients with NLR of 6.02 or lower had a 2.901-fold risk of osteomyelitis. When ESR was evaluated with neutrophil percentage, lymphocyte percentage and NLR, the sensitivity was calculated as 86.76% for osteomyelitis. ConclusionWe believe that the immune response caused by bone exposure to the environment is different than the immune response caused by soft tissue infection in the classical diabetic foot. The combined evaluation of multiple diagnostic parameters increases the sensitivity of osteomyelitis diagnosis.

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The Role of Inflammatory Markers: WBC, CRP, ESR, and Neutrophil-to-Lymphocyte Ratio (NLR) in the Diagnosis and Management of Diabetic Foot Infections

Cited by 5 publications

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Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Prophylactic or therapeutic administration of Holarrhena floribunda hydro ethanol extract suppresses Complete Freund’s Adjuvant-induced arthritis in Sprague-Dawley rats

Evaluation of osteomyelitis in diabetic foot ulcers with exposed bone

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The Role of Inflammatory Markers: WBC, CRP, ESR, and Neutrophil-to-Lymphocyte Ratio (NLR) in the Diagnosis and Management of Diabetic Foot Infections

Cited by 5 publications

References 0 publications

Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Prophylactic or therapeutic administration of Holarrhena floribunda hydro ethanol extract suppresses Complete Freund’s Adjuvant-induced arthritis in Sprague-Dawley rats&nbsp;&nbsp;&nbsp;&nbsp;

Evaluation of osteomyelitis in diabetic foot ulcers with exposed bone

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Prophylactic or therapeutic administration of Holarrhena floribunda hydro ethanol extract suppresses Complete Freund’s Adjuvant-induced arthritis in Sprague-Dawley rats