The potential impact and diagnostic value of inflammatory markers on diabetic foot progression in type II diabetes mellitus: A case–control study
Amal Ahmed Mohamed, Mona Abd Elmotaleb Hussein, Ihab Nabil Hanna, Abdulqadir J. Nashwan, Mohamed A. Saleh, Wafaa Y. Abdel Wahed, Asmaa Mohamed Mohamed Mansour, Mohamed Ramadan Ezz Al Arab, Naglaa Fawzy, Yasser Sakr, Hassan Shalby, Eman Alhussain Abdulgawad, Marwa K. Darwish, Heba Elosaily, Mervat Naguib, Ahmed Ali Mohamed, Waleed Farouk Mohamed, Wael Hafez
Abstract
The wound-healing process in diabetic foot is affected by pro and anti-inflammatory markers, and any disruption in the inflammatory reaction interferes with tissue homeostasis, leading to chronic non-wound healing. This study aimed to determine the diagnostic value and effect of CRP, IL-6, TNF, and HbA1c on initiation the and progression of diabetic foot ulcers. ELISA was used to quantify IL-6, TNF, CRP, and HbA1c in 205 patients with diabetes, and 105 were diabetic foot free. The prevalence and progression of diabetic foot were also evaluated. The area under the curve (AUC) was calculated using the receiver operating characteristic (ROC) curve to analyze the predictive values. Forward stepwise logistic regression analysis was used to compute the odds ratio (OR) and the corresponding 95% confidence intervals (CIs). CRP, IL-6, and FBS were found to be significant predictors of diabetic foot (OR = 1.717, 95% CI = 1.250–2.358, P = 0.001; OR = 1.434, 95% CI = 1.142–1.802, P = 0.002; and OR = 1.040, 95% CI = 1.002–1.080, P = 0.037), respectively. The AUCs for CRP, IL-6, and HbA1c in predicting diabetic foot were 0.839, 0.728, and 0.834, respectively, demonstrating a good predictive value for each diagnostic marker. The current study demonstrated that IL-6, CRP, and HbA1c may be useful biomarkers to indicate diabetic foot progression. Furthermore, our findings showed a substantial relationship between CRP and HbA1c in individuals with diabetic foot conditions. Dado que los marcadores inflamatorios pueden influir en la capacidad del pie diabético para curar heridas, la interrupción de la respuesta inflamatoria puede dar lugar a una ausencia de curación crónica de las heridas. Determinar el valor predictivo de PCR, IL-6, TNF y HbA1C en la identificación de úlceras de pie diabético y su progresión. Se utilizó el método ELISA para cuantificar IL-6, TNF, PCR y HbA1C en 205 diabéticos, y 105 no tenían pie diabético. Se evaluó la prevalencia y la progresión del pie diabético. Se observó un marcado aumento en CRP, HbA1C e IL-6 entre las personas con pie diabético. Los OR para PCR, IL-6 y HbA1C: 1,359 (IC 95% = 1,189–1,554, p = 0,001), 1,245 (IC 95% = 1,091–1,420, p = 0,001) y 1,866 (IC 95% = 1.238–2.814, p = 0.003), respectivamente. Las áreas bajo la curva para CRP, IL-6 y HbA1C en la predicción del pie diabético fueron 0,839, 0,728 y 0,834, respectivamente, lo que demuestra un buen valor predictivo para cada marcador de diagnóstico. El presente estudio demostró que IL-6, CRP y Hb A1C pueden ser biomarcadores útiles para el pronóstico del pie diabético. Además, nuestros hallazgos muestran una relación sustancial entre PCR y Hb A1C para personas con pie diabético.