| Objective: To discuss the implication of white blood cell(WBC),C-reactive protein(CRP)and procalcitonin(PCT)in the severity and prognosis evaluation of the diabetic foot infection(DFI)patients.Methods: This was a clinical observation test. A total of 118 patients who met with the inclusion and diagnosed with DFI hospitalized in Metabolic Hospital of Tianjin Medical University from September 2013 to September 2014 were enrolled. The clinical data of the patients were recorded in detail. Levels of CRP and WBC were obtained first at admission and then 1 week after standard treatment. We collected the serum and determined the level of PCT with double antibody sandwich enzyme-linked immunosorbent assay(ELISA). 1. The patients were grouped into mild,moderate and severe infection group according to the IDSA criteria,baseline PCT,CRP and WBC level were compared among the three groups;2. According to whether complicated with osteomyelitis,patients were divided into osteomyelitis group and non- osteomyelitis group,baseline PCT,CRP and WBC level were also compared between the two groups; 3. The difference of the baseline and post-treatment WBC,CRP and PCT were compared in mild,moderate and severe infection group using the matching t test;4. According to the prognosis,patients were divided into amputation group and non-amputation group and the clinical characteristics were analyzed. Potential risk factors for amputation were examined using the multivariate analyses;5. Receiver operating characteristic(ROC)curves were generated to determine the predictability of the serum inflammation indicators for amputations.Results: 1.The level of baseline PCT and CRP were significantly different among the mild,moderate,severe groups(P<0.05)and the levels were increased along with the degree of infection. There was no statistical significance of WBC between mild and moderate infection group; 2.Compared with non- osteomyelitis group,the level of serum PCT and CRP were significantly higher in osteomyelitis group(P<0.05). While there was no statistical significance of WBC between two groups; 3.The level of post-treatment serum CRP and PCT were significantly declined compared withbaseline level(P<0.05),while for WBC was not; 4.Compared with non-amputation group, more patients were with limb ischemia, osteomyelitis, deep ulcer, hypoproteinemia,hyperlipemia and high level of baseline and post-treatment PCT,CRP and WBC( P<0.05). Logistic regression analysis demonstrated that limb ischemia(OR=8.228;95%CI=1.624-41.694;P=0.011), osteomyelitis(OR=9.296;95%CI=1.830-47.227;P=0.007), a 1-SD increase in baseline PCT(OR=6.499;95%CI=1.785-23.664;P=0.005)and CRP(OR=4.433;95%CI=1.391-14.130;P=0.012)were independent risk factors for amputation; 5. The area under the PCT curve of ROC(AUC) was higher than that of baseline CRP(0.868VS0.846).Conclusion: Limb ischemia, osteomyelitis,baseline PCT and CRP were independent risk factors for amputation. There is a positive correlation of the level of serum PCT and CRP with severity of diabetic foot infection. The level of WBC cannot differentiate between the mild and moderate infection. The increasing baseline level of PCT and CRP could help clinical doctors to assess the risks of amputation,and serum PCT is better than CRP. Combination the clinical characteristic and serum inflammation indicators could help the doctors to judge the degree of infection in DF patients, so as to shorten the healing time and increase the rate of wound healing, reduce the amputation occurrence. |
