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 Jeprel Japer Nashwan; Mohamed Saleh; Wafaa Yousif Abdel Wahed; Asmaa Mohamed Mohamed Mansour; Mohamed Ramadan Ezz Al Arab; Naglaa Fawzy; Yasser Sakr; Hassan Shalby; Eman AlHussain; Marwa Kamal Darwish; Heba El-Osaily; Mervat Naguib; Ahmed Ali Mohamed; Waleed Farouk Mohamed; Wael Hafez

doi:10.1016/j.medcli.2024.01.009

The potential impact and diagnostic value of inflammatory markers on diabetic foot progression in type II diabetes mellitus: A case-control study

Med Clin (Barc). 2024 Mar 7:S0025-7753(24)00081-2. doi: 10.1016/j.medcli.2024.01.009. Online ahead of print.

[Article in English, Spanish]

Authors

Amal Ahmed Mohamed¹, Mona Abd Elmotaleb Hussein², Ihab Nabil Hanna³, Abdulqadir Jeprel Japer Nashwan⁴, Mohamed Saleh⁵, Wafaa Yousif Abdel Wahed⁶, Asmaa Mohamed Mohamed Mansour⁷, Mohamed Ramadan Ezz Al Arab⁸, Naglaa Fawzy⁹, Yasser Sakr⁹, Hassan Shalby¹⁰, Eman AlHussain¹¹, Marwa Kamal Darwish¹², Heba El-Osaily¹³, Mervat Naguib¹⁴, Ahmed Ali Mohamed¹⁵, Waleed Farouk Mohamed¹⁶, Wael Hafez¹⁷

Affiliations

¹ Biochemistry Department, National Hepatology and Tropical Medicine Research Institute, Gothi, Egypt.
² Internal Medicine Department, National Institute of Diabetes and Endocrinology, Egypt.
³ Surgical Department, National Institute of Diabetes and Endocrinology, Egypt.
⁴ Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. Electronic address: anashwan@hamad.qa.
⁵ Gastroentrology Department, National Hepatology and Tropical Medicine Research Institute, Egypt.
⁶ Public Health and Community Medicine, Faculty of Medicine, Fayoum University, Egypt.
⁷ Biochemistry Department, Faculty of Science, Fayoum University, Egypt.
⁸ Hepatology and Gastroenterology Department, Ahmed Maher Teaching Hospital, Egypt.
⁹ Clinical and Chemical Pathology Department, National Institute of Diabetes and Endocrinology, Egypt.
¹⁰ Internal Medicine Department, Faculty of Medicine, Misr University for Science and Technology, Egypt.
¹¹ Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Egypt.
¹² Chemistry Department (Biochemistry Branch), Faculty of Science, Suez University, Suez 43518, Egypt.
¹³ Biochemistry Department, Faculty of Pharmacy, Ahram Canadian University, Egypt.
¹⁴ Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt.
¹⁵ Intensive Care Unit, Theodor Bilharz Research Institute, Giza, Egypt.
¹⁶ Healthpoint Hospital, Abu Dhabi, United Arab Emirates.
¹⁷ Internal Medicine Department, National Research Centre, Elbohoos Street, Dokki, Giza, Egypt.

PMID: 38458959
DOI: 10.1016/j.medcli.2024.01.009

Abstract

Background: 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.

Aim: 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.

Method: 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).

Results: 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.

Conclusion: 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.

Keywords: CRP; Citocina inflamatoria; Diabetes; Foot ulcer; HbA1C; HbA1c; IL-6; Inflammatory cytokine; PCR; TNF; Úlcera del pie.