Clinical Value Of Serum Cystatin C Levels On The Severity And Prognosis Of Diabetic Foot Ulceration In Type 2 Diabetes Patients

Background and Objectives Diabetic foot ulcer is the leading cause of non-traumatic amputation.The aim of this study was to investigate the relationship between serum Cystatin C levels and the Wagner grades,and the prognosis of diabetic foot ulceration(DFU).Methods This cross-sectional and cohort follow-up study were recruited patients with Type 2 diabetes.After a 1-year follow-up,DFUs were grouped into healed and non-healed group based on the clinical outcome of ulcer.Clinical parameters and biochemical parameters were collected.The severity of foot ulcerations,the healing rate of ulcerations and their association with serum Cystatin C were compared and analyzed with Spearman correlation and Logistic regression analysis.Results 1.Spearman correlation and Logistic regression analysis revealed that Cystatin C was an independent impact factor for DFU Wagner grades(b=1.381,95%CI: 1.039-15.228,P<0.01)even after adjusting for all potential confounders.After adjustments for age,diabetes duration,renal function and infection control,multiple logistical regression analysis revealed that Cystatin C still linked with increased risk of undesirable DFU outcome(OR=7.279,95% CI: 1.299-40.784,P<0.05).2.Receiver-operating characteristic analysis revealed that the optimal cutoff point of serum Cystatin C to indicate DFU Wagner grades was 1.45 mg/L.High serum Cystatin C level indicated three-fold higher risk of severe ulcer grades.And Cystatin C >1.35 mg/L predicted more than 6-fold increased risk of incurable foot ulceration.Conclusions There is a strong and independent association between high Cystatin C and both the Wagner level and the prognosis of diabetic foot ulcer,and serum Cystatin C higher than 1.45mg/L indicates the three-time increased risk of severe ulcer grades.Cystatin C higher than 1.35mg/L predicts 6-fold increased risk of incurable ulcer.