Serum Procalcitonin (PCT) - Is there a Role as an Early Biomarker in Infected Diabetic Foot Ulcer (IDFU) Patients?

J Omar; N S Ahmad; Naa Che-Soh; W N Wan-Azman; N M Yaacob; N S Abdul-Ghani; M R Abdullah

doi:10.5704/MOJ.2307.010

Serum Procalcitonin (PCT) - Is there a Role as an Early Biomarker in Infected Diabetic Foot Ulcer (IDFU) Patients?

Malays Orthop J. 2023 Jul;17(2):62-69. doi: 10.5704/MOJ.2307.010.

Authors

J Omar¹, N S Ahmad², Naa Che-Soh¹, W N Wan-Azman¹, N M Yaacob³, N S Abdul-Ghani⁴, M R Abdullah⁵

Affiliations

¹ Department of Chemical Pathology, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
² Department of Pathology, Hospital Bintulu Sarawak, Bintulu, Malaysia.
³ Department of Biostatistic, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
⁴ Department of Orthopaedic, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
⁵ Department of Community Medicine, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Abstract

Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU).

Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and C-reactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification.

Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL.

Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

Keywords: biomarker; infected diabetic foot ulcer; procalcitonin.