Tohoku J. Exp. Med., 2007, 213(4)

Procalcitonin as a Diagnostic Aid in Diabetic Foot Infections

GUNALP UZUN,¹ EMRULLAH SOLMAZGUL,² HAYRETTIN CURUKSULU,³ VEDAT TURHAN,⁴ NURITTIN ARDIC,⁵ CIHAN TOP,² SENOL YILDIZ¹ and MAIDE CIMSIT⁶

¹Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey
²Department of Internal Medicine, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey
³Department of Clinical Biochemistry, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey
⁴Department of Infectious Diseases, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey
⁵Department of Microbiology, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey
⁶Department of Underwater and Hyperbaric Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey

The diagnosis of diabetic foot infection (DFI) is usually a challenge to the clinician. Procalcitonin (PCT), a 116-amino acid propeptide of calcitonin, is a new marker of bacterial infections and sepsis. We evaluated the serum value of PCT as a marker of bacterial infection in diabetic patients with foot ulcers. Forty-nine diabetic patients with foot ulcers were consecutively enrolled into the study. DFI was diagnosed clinically by the presence of purulent secretions or at least two of the symptoms of inflammation including redness, warmth, swelling, and pain. According to these criteria, DFI was determined in 27 patients (DFI group) and not detected in 22 patients (NDFI group). The blood samples were taken for biochemical analysis on admission. PCT, white blood cell count (WBC) and erythrocyte sedimentation rate (ESR), but not C-reactive protein (CRP), was found significantly higher in DFI group compared with NDFI group. The best cut-off value, sensitivity and specificity were 0.08 ng/ml, 77% and 100% for PCT, 32.1 mg/dl, 29% and 100% for CRP, 8.6 10⁹/L, 70% and 72% for WBC and 40.5 mm/h, 77% and 77% for ESR, respectively. The area under the receiver operating characteristic curve for infection identification was greatest for PCT (0.859; p < 0.001), followed by WBC (0.785; p = 0.001), ESR (0.752; p = 0.003), and finally CRP (0.625; p = 0.137). These results suggest that PCT may be a useful diagnostic marker for DFI. Additional research is needed to better define the role of PCT in DFI.

keywords —— procalcitonin; infection marker; C-reactive protein; erythrocyte sedimentation rate; white blood cell count

© 2007 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2007, 213, 305-312

Correspondence: Dr. Gunalp Uzun, Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, 34668, Kadikoy, Istanbul, Turkey.

e-mail: gunalpuzun@yahoo.com