Jeffcoate WJ, Harding KG: Diabetic foot ulcers. .Lancet 361::1545. ,2003. .
American Diabetes Association. Consensus Development Conference on Diabetic Foot Wound Care: 7–8 April 1999, Boston, Massachusetts. .Diabetes Care 22::1354. ,1999. .
Lipsky BA, Berendt AR, Deery HG, et al: Diagnosis and treatment of diabetic foot infections. .Clin Infect Dis 39::885. ,2004. .
Reiber GE, Pecoraro RE, Koepsell TD: Risk factors for amputation in patients with diabetes mellitus: a case-control study. .Ann Intern Med 117::97. ,1992. .
Mayfield JA, Reiber GE, Nelson RG, et al: A foot risk classification system to predict diabetic amputation in Pima Indians. .Diabetes Care 19::704. ,1996. .
Flores Rivera AR: Risk factors for amputation in diabetic patients: a case-control study. .Arch Med Res 29::179. ,1998. .
Treece KA, Macfarlane RM, Pound N, et al: Validation of a system of foot ulcer classification in diabetes mellitus. .Diabet Med 21::987. ,2004. .
Winkley K, Stahl D, Chalder T, et al: Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer. .J Diabetes Complications 21::341. ,2007. .
Oyibo SO, Jude EB, Tarawneh I, et al: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. .Diabetes Care 24::84. ,2001. .
Calhoun JH, Cantrell J, Cobos J, et al: Treatment of diabetic foot infections: Wagner classification, therapy, and outcome. .Foot Ankle 9::101. ,1988. .
Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system: the contribution of depth, infection, and ischemia to risk of amputation. .Diabetes Care 21::855. ,1998. .
Most RS, Sinnock P: The epidemiology of lower extremity amputations in diabetic individuals. .Diabetes Care 6::87. ,1983. .
Faglia E, Favales F, Morabito A: New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993: a 6.5-year follow-up. .Diabetes Care 24::78. ,2001. .
Johnson HL, Chiou CC, Cho CT: Applications of acute phase reactants in infectious diseases. .J Microbiol Immunol Infect 32::73. ,1999. .
Black S, Kushner I, Samols D: C-reactive protein. .J Biol Chem 279::48487. ,2004. .
Cassar K, Bachoo P, Ford I, et al: Markers of coagulation activation, endothelial stimulation and inflammation in patients with peripheral arterial disease. .Eur J Vasc Endovasc Surg 29::171. ,2005. .
Colten HR: Tissue-specific regulation of inflammation. .J Appl Physiol 72::1. ,1992. .
Thompson D, Whicher JT, Banks RE: Acute phase reactants in predicting disease outcome. .Baillieres Clin Rheumatol 6::393. ,1992. .
Volaco A, Chantelau E, Richter B, et al: Outcome of critical foot ischaemia in longstanding diabetic patients: a retrospective cohort study in a specialised tertiary care centre. .Vasa 33::36. ,2004. .
Lipsky BA, Sheehan P, Armstrong DG, et al: Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial. .Int Wound J 4::30. ,2007. .
Akanji AO, Famuyiwa OO, Adetuyibi A: Factors influencing the outcome of treatment of foot lesions in Nigerian patients with diabetes mellitus. .Q J Med 73::1005. ,1989. .
Eneroth M, Apelqvist J, Stenstrom A: Clinical characteristics and outcome in 223 diabetic patients with deep foot infections. .Foot Ankle Int 18::716. ,1997. .
Pittet D, Wyssa B, Herter-Clavel C, et al: Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up. .Arch Intern Med 159::851. ,1999. .
Armstrong DG, Lavery LA, Sariaya M, et al: Leukocytosis is a poor indicator of acute osteomyelitis of the foot in diabetes mellitus. .J Foot Ankle Surg 35::280. ,1996. .
Butalia S, Palda VA, Sargeant RJ, et al: Does this patient with diabetes have osteomyelitis of the lower extremity?. JAMA 299::806. ,2008. .
Kaleta JL, Fleischli JW, Reilly CH: The diagnosis of osteomyelitis in diabetes using erythrocyte sedimentation rate: a pilot study. .JAPMA 91::445. ,2001. .
Roine I, Faingezicht I, Arguedas A, et al: Serial serum C-reactive protein to monitor recovery from acute hematogenous osteomyelitis in children. .Pediatr Infect Dis J 14::40. ,1995. .
Background: Prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and post-treatment levels of acute phase reactants in the outcome of patients with diabetic foot infections.
Methods: We collected data prospectively during minimum follow-up of 6 months in patients with infected diabetic foot ulcers hospitalized in Dokuz Eylul University Hospital between January 1, 2003, and January 1, 2008. After excluding patients who did not attend the hospital for follow-up visits regularly (n = 36), we analyzed data from 165 foot ulcer episodes.
Results: Limb ischemia and osteomyelitis were much more frequent in patients who underwent amputation. Wagner grade, which assesses ulcer depth and the presence of osteomyelitis or gangrene, was higher in patients who needed amputation. Ulcer size was slightly larger in the amputation group. Baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, white blood cell counts, and platelet counts were significantly elevated in patients who underwent amputation. Albumin levels were significantly suppressed in the amputation group. Univariate analysis showed that a 1-SD increase in baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, and white blood cell counts and a 1-SD decrease in post-treatment albumin levels were significantly associated with increased risk of amputation. Post-treatment C-reactive protein level was strongly associated with amputation risk.
Conclusions: Circulating levels of acute phase reactants were associated with amputation risk in diabetic foot infections. (J Am Podiatr Med Assoc 101(1): 1–6, 2011)