Serum Procalcitonin ,Cystatin C, Kidney Injury Molecule -1 Levels in Patients with Diabetic Foot Ulcer and Relation with Chronic Kidney Disease

Authors

  • Ahmed Malik Hassan College of Applied Medical Sciences, University of Karbala, Karbala, Iraq.
  • Hassan Ali Al-Saadi College of Applied Medical Sciences, University of Karbala, Karbala, Iraq.
  • Radhwan Mohammed Hussein College of Pharmacy, University of Ahl Al Bait, Kerbala, Iraq.
  • Munther Jaffar Hussain Faculty of Life Science and Medicine, Kings College, London, UK.

DOI:

https://doi.org/10.22317/jcms.v10i4.1596

Keywords:

Procalcitonin, Cystatin C, Foot Ulcer, Diabetic, Renal Insufficiency, Chronic.

Abstract

Objective: To evaluate the serum levels of Procalcitonin (PCT), C-Reactive Protein (CRP), Cystatin C, and Kidney Injury Molecule-1 (KIM-1) in patients with diabetic foot ulcers (DFU).

Methods: This case-control study included 120 participants divided into four groups: 30 with diabetic foot ulcers (DFU), 30 with diabetic foot ulcers and chronic kidney disease (DFU & CKD), 30 with diabetes mellitus (DM), and 30 healthy controls. The study was conducted from November 2023 to March 2024. Laboratory tests performed on all patients and controls included CBC, blood urea, serum creatinine, and serum CRP levels using a fully automated analyzer. PCT, Cystatin C, and KIM-1 levels were measured using the ELISA method.

Results: The biomarkers PCT, CRP, and WBC showed a significant increase in the diabetic foot group and the diabetic foot with chronic kidney disease group. Additionally, there were positive correlations between PCT and CRP and Cystatin C, and between KIM-1 and Cystatin C. ROC analysis of PCT demonstrated high sensitivity and specificity (91.1% and 99%, respectively).

Conclusion: Elevated Procalcitonin levels in diabetic foot patients can predict early infection even without clear clinical signs. Increased levels of Cystatin C and KIM-1 serve as good biomarkers for renal function and complications of diabetes, showing a close relationship with diabetic foot conditions.

References

Pichu S, Patel BM, Apparsundaram S, Goyal RK. Role of biomarkers in predicting diabetes complications with special reference to diabetic foot ulcers. Vol. 11, Biomarkers in Medicine. 2017. p. 377–88.

Atlaw, Asegdew, et al. "Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia." Frontiers in Endocrinology 13 (2022): 987487.‏

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54: e132–e173.

. Singh S, Pai DR, Yuhhui C. Diabetic foot ulcer − diagnosis and management. Clin Res Foot Ankle 2013; 1:120.

Saleem, Sheikh Mohd, S. S. Khan, and Shah Sumaya Jan. "Role of serum procalcitonin level in early diagnosis of bacterial pneumonia in children, a hospital-based study." Int J Res Med Sci 4 (2016): 1518-1521.‏

Oberhoffer M, Stonans I, Russwurm S, Stonane E, Vogelsang H, Junker U, et al. Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis-related cytokines in vitro. J Lab Clin Med 1999; 134:49–55.

Bongiovanni C, Magrini L, Salerno G, Gori CS, Cardelli P, Hur M, et al. Serum Cystatin C for the Diagnosis of Acute Kidney Injury in Patients Admitted in the Emergency Department. Vol. 2015, Disease Markers. 2015.

Uzun G, Solmazgul E, Curuksulu H, Turhan V, Ardic N, Top C, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 2007; 213:305–312.

Jeandrot A, Richard JL, Combescure C, Jourdan N, Finge S, Rodier M, et al. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia 2008; 51:347–352.

Al-Nori MKJ, Ahmed AJ. The role of serum cystatin C as an early predictor for the diagnosis of chronic kidney disease in Mosul City. Vol. 14, Iraqi Journal of Pharmacy. 2019. p. 76–8.

PEI, Yuanyuan, et al. Serum cystatin C, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, klotho and fibroblast growth factor-23 in the early prediction of acute kidney injury associated with sepsis in a Chinese emergency cohort study. European journal of medical research, 2022, 27.1: 39.‏

Brozat, Jonathan Frederik, et al. "Elevated Serum KIM-1 in Sepsis Correlates with Kidney Dysfunction and the Severity of Multi-Organ Critical Illness." International Journal of Molecular Sciences 25.11 (2024): 5819.‏

Seibert, Felix S., et al. “Prognostic value of urinary calprotectin, NGAL and KIM-1 in chronic kidney disease.” Kidney and Blood Pressure Research 43.4 (2018): 1255–1262.

JAFARI, Nematollah Jonaidi, et al. Can procalcitonin be an accurate diagnostic marker for the classification of diabetic foot ulcers?. International journal of endocrinology and metabolism, 2014, 12.1.

El-Kafrawy NA, Shaaban MA, Korany MA, Sonbol AA, Ata MB. Procalcitonin as a marker of diabetic foot ulcer infection. Vol. 31, The Egyptian Journal of Internal Medicine. 2019. p. 652–7.

MASSARA, Mafalda, et al. The role of procalcitonin as a marker of diabetic foot ulcer infection. International wound journal, 2017, 14.1: 31–34.

Umapathy, Dhamodharan, et al. “Potential of circulatory procalcitonin as a biomarker reflecting inflammation among South Indian diabetic foot ulcers.” Journal of vascular surgery 67.4 (2018): 1283–1291.

ONG, Eric, et al. The role of inflammatory markers: WBC, CRP, ESR, and neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and Management of Diabetic Foot Infections. In: Open Forum Infectious Diseases. Infectious Diseases Society of America, 2015. p. 1526.

Ai L, Hu Y, Zhang X, Zeng H, Zhao J, Zhao J, et al. High cystatin C levels predict undesirable outcome for diabetic foot ulcerations. Vol. 24, Wound Repair and Regeneration. 2016. p. 560–7.

An, Jingsi, et al. “Value of cystatin C in predicting recurrence in patients with severe diabetic foot and diabetic foot ulcer.” Biomarkers in Medicine 17.5 (2023): 287–296.

Fatemi, Shahab, et al. “Copeptin, B-type natriuretic peptide and cystatin C are associated with incident symptomatic PAD.” Biomarkers 24.6 (2019):615–621.

Yin, Caixia, and Ningning Wang. “Kidney injury molecule-1 in kidney disease.” Renal failure 38.10 (2016): 1567–1573.

De Silva, P. Mangala CS, et al. “Urinary biomarkers of renal injury KIM-1 and NGAL: reference intervals for healthy pediatric population in Sri Lanka.” Children 8.8 (2021): 684.

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Published

2024-08-30

How to Cite

Hassan, A. M., Al-Saadi, H. A., Hussein , R. M., & Hussain, M. J. (2024). Serum Procalcitonin ,Cystatin C, Kidney Injury Molecule -1 Levels in Patients with Diabetic Foot Ulcer and Relation with Chronic Kidney Disease. Journal of Contemporary Medical Sciences, 10(4). https://doi.org/10.22317/jcms.v10i4.1596