article · Medicina Clínica
This study examined the diagnostic utility of specific inflammatory and metabolic markers in the development and progression of diabetic foot ulcers among individuals with type II diabetes. Tissue healing disruptions in diabetic foot conditions are closely linked to inflammatory imbalances. Researchers measured levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor (TNF), and glycated haemoglobin (HbA1c) using ELISA across patient groups with and without diabetic foot ulcers. The findings showed that elevated levels of CRP, IL-6, fasting blood sugar, and HbA1c serve as significant indicators of diabetic foot conditions. Specifically, receiver operating characteristic analysis demonstrated strong predictive values for CRP, HbA1c, and IL-6. A notable correlation was also identified between CRP and HbA1c levels, indicating that these circulating markers reflect the underlying disease state and could help identify individuals experiencing diabetic foot ulcer progression.
Diabetic foot ulcers represent a severe complication of diabetes that often fails to heal due to altered inflammatory responses. By establishing that common blood markers such as CRP, IL-6, and HbA1c accurately reflect ulcer progression, this research supports the potential for earlier clinical identification and better management of patients at higher risk of non-healing diabetic wounds.
This research provides clinical evidence that could support the development of diagnostic panels or risk-stratification software for diabetic foot ulcer management. Healthcare providers and diagnostic laboratories are the primary end users. The findings represent early-stage, observational research using standard ELISA assays, meaning further validation and clinical integration studies would be required before translation into specialised commercial prognostic tools.
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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.
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DOI: 10.1016/j.medcli.2024.01.009
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