Procalcitonin and Diabetic Foot Ulcer Infections: A Meta‐Analysis

TL;DR

This study finds that procalcitonin levels are higher in people with infected diabetic foot ulcers, suggesting it could help detect infections early.

Contribution

The study provides new evidence supporting procalcitonin as a potential biomarker for early detection of diabetic foot ulcer infections.

Findings

Procalcitonin levels were significantly higher in infected diabetic foot ulcers compared to non-infected ones.

Subgroup analysis showed a stronger association in Asian populations.

BMI and HbA1c were identified as major sources of heterogeneity in the results.

Abstract

Procalcitonin (PCT) is an effective inflammatory marker for diagnosing infection. We assessed the clinical utility of procalcitonin in diagnosing diabetic foot infections.

This meta‐analysis adhered to the PRISMA guidelines. We searched PubMed, Web of Science, Embase and the Cochrane Library for studies on PCT for the diagnosis of diabetic foot published before 1 July 2024. The primary outcome was the standardised mean difference (SMD) in PCT levels between IDFU and non‐IDFU groups, with corresponding 95% confidence intervals (CI). The included studies were cross‐sectional and cohort studies, so the quality of the literature was assessed using the Newcastle–Ottawa Scale (NOS) evaluation criteria. This study's statistical analyses were conducted solely with STATA 15.0 software.

Ten studies comprising 928 patients were ultimately included. There were six cross‐sectional studies and four cohort studies. In total, 532 patients were assigned to the IDFU group and 396 to the non‐infected diabetic foot ulcers (NIDFU) group. The relationship between PCT and DFU was evaluated in ten studies, with significant heterogeneity among the included studies (x
2 = 54.10, p = 0.00001; I
2 = 83.6%). Therefore, a random effects model was used with a pooled standardised mean difference of 0.79 (95% confidence interval [CI]: 0.43–1.14). The Egger experiment results (t = 0.43, p = 0.680) indicated that there was no publication bias. Analysis of sensitivity revealed that the results were reliable. Subgroup analyses identified the area as a significant source of heterogeneity. The random‐effects model's meta‐regression results revealed that BMI (p = 0.026) and HbA1c (p = 0.016) had a significant impact on the heterogeneity of the association between IDFU and PCT levels.

Our study showed a significant correlation between serum PCT levels and IDFU. Identification and treatment of IDFUs as soon as possible can help reduce amputation and mortality rates.

This systematic review and meta‐analysis evaluated the association between serum procalcitonin levels and diabetic foot infections. Ten studies were included, and a random‐effects model showed significantly higher procalcitonin levels in infected patients, supporting its role as a potential diagnostic biomarker for early infection detection in diabetic foot ulcers.

This meta‐analysis of 10 studies involving 928 patients showed that procalcitonin (PCT) levels were significantly higher in patients with infected diabetic foot ulcers (IDFU) compared to those with non‐infected ulcers (NIDFU). Subgroup analysis indicated a stronger association in Asian populations (SMD = 1.15), and meta‐regression identified BMI and HbA1c as major sources of heterogeneity. These findings suggest that PCT may serve as a promising serum biomarker for early identification of infection in diabetic foot ulcers, potentially aiding timely clinical intervention and reducing the risk of amputation and mortality

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