Procalcitonin and Diabetic Foot Ulcer Infections: A Meta-Analysis

Abstract

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

Method: 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.

Result: 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 (x² = 54.10, p = 0.00001; I² = 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.

Conclusion: 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.

Keywords: PRISMA guidelines; diabetic foot ulcers; infection; inflammatory biomarkers; procalcitonin.