Effectiveness of Procalcitonin as a Diagnostic Marker vs Other Inflammatory Markers in Infected Diabetic Foot Ulcers: A Case-control Study

Abstract

Introduction: Procalcitonin (PCT), is an amino acid protein precursor of calcitonin hormone, which is released by thyroid parafollicular cells or other body cells. Procalcitonin alone or along with other biomarkers of infection such as erythrocyte sedimentation rate( ESR) and C-reactive protein (CRP) can be used as a marker for diagnosing diabetic foot infection. Aim: To determine the effectiveness of PCT, as a marker for infected Diabetic Foot Ulcer (DFU) in comparison with other inflammatory markers such as CRP, White Blood Cell count (WBC), and ESR. Materials and Methods: This case-control study was conducted at Department of General Surgery, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India from January 2018 to December 2018. Total 90 patients were classified into three groups with 30 patients in each group: group I had patients with diabetes but without foot ulcers while group II patients having Non infected DFU (NIDFU) and group III patients having Infected Diabetic Foot Ulcer (IDFU) served as cases. The parameters assessed were demographic data, blood pressure, Body Mass Index (BMI), diabetic complications like nephropathy, retinopathy and myocardial ischaemia and inflammatory markers. Results: The mean age in group I was 46.9±5.11 years., group II was 47.8±6.65 years and in group III was 49.3±7.83 years. The gender distribution were group I (male 19, female 11), group II (male 13, female 17), group III (male 14, female 16). Serum PCT levels were 1.43±0.52 ng/mL in group III versus 0.18±0.17 ng/mL and 0.08±0.05 ng/mL in group II and group I respectively, with a significant p-value of 0.001. The PCT levels was significantly higher in patients with IDFU compared with the traditional markers like CRP (53.8±16.4 mg/dL, p-value=0.001), ESR (49.0±9.24 mm/hr, p-value=0.034) and WBC (10.2±3.18×109 / dL, p-value=0.014). Conclusion: It was concluded that PCT, as a vital biochemical parameter, has an significant role to diagnose the infection in DFU as compared to CRP, WBC count and ESR.