• Logo
  • SBMUJournals

Pro-Calcitonin, Erythrocyte Sedimentation Rate and C - reactive Protein in Predicting Diabetic Foot Ulcer Characteristics; a Cross Sectional Study

Fahimeh Hadavand, Atefeh Amouzegar, Hessam Amid




Introduction: Considering the importance of early diagnosis of diabetic foot ulcers and its complications, this study aimed to evaluate the accuracy of erythrocyte sedimentation rate (ESR), C - reactive protein (CRP), and pro-calcitonin (PCT) in predicting the ulcer class, osteomyelitis, and peripheral arterial disease (PAD).

Methods: This cross-sectional study was performed on 200 consecutive patients suffering from diabetic foot ulcer who were referred to Infectious Disease Ward. The levels of PCT, ESR, and CRP were measured for all patients and the screening performance characteristics of each marker in predicting the ulcer class, osteomyelitis, and PAD was calculated.

Results: The levels of PCT, ESR and CRP were significantly higher in patients with class IV foot ulcer compared to those with class III ulcers (p<0.001). Patients with evidence of osteomyelitis had significantly higher level of PCT, ESR and CRP. The best cutoff points of PCT, ESR and CRP in predicting osteomyelitis were 0.35 ng/ml (86.1% sensitivity, 45.3% specificity), 56.5 mm/hours (95.8% sensitivity, and 50.0% specificity) and 44 mg/ml (90.3% sensitivity, 57.0% specificity), respectively. The presence of PAD was significantly associated with increased levels of the three biomarkers. The best cutoff values for PCT, ESR and CRP in predicting PAD were 0.45 (70.8% sensitivity, 71.7% specificity), 61.5 (83.3% sensitivity, 52.0% specificity) and 49 (83.3% sensitivity, 63.8% specificity), respectively.

Conclusion: Based on the findings of the present study, although the accuracy of PCT, ESR, and CRP in predicting the severity of diabetic foot ulcers was fair, increase in the three parameters can predict the occurrence of osteomyelitis and PAD following diabetic food development with good accuracy and acceptable sensitivity.


blood sedimentation; procalcitonin; diabetic foot; peripheral arterial disease


Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes care. 2004;27(5):1047-53.

Kalish J, Hamdan A. Management of diabetic foot problems. Journal of vascular surgery. 2010;51(2):476-86.


Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones. 2009;8(4):286-95.

Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clinical infectious diseases. 2004;39(2):206-17.

Assicot M, Bohuon C, Gendrel D, Raymond J, Carsin H, Guilbaud J. High serum procalcitonin concentrations in patients with sepsis and infection. The Lancet. 1993;341(8844):515-8.

Hammer S, Meisner F, Dirschedl P, Höbel G, Fraunberger P, Meiser B, et al. Procalcitonin: a new marker for diagnosis of acute rejection and bacterial infection in patients after heart and lung transplantation. Transplant immunology. 1998;6(4):235-41.

Kordek A, Podraza W, Czajka R. Reliability of semiquantitative determination of procalcitonin serum concentrations in neonates. Diagnostic microbiology and infectious disease. 2006;56(1):31-4.

Barati M, Eshaghi M, Noori N. EVALUATION OF CORRELATION BETWEEN ESR AND CRP WITH OSTEOMYLITIS IN DIABETIC FOOT. Razi Journal of Medical Sciences. 2003;10(33):9-15.

Armstrong DG, Perales TA, Murff RT, Edelson GW, Welchon JG. Value of white blood cell count with differential in the acute diabetic foot infection. Journal of the American Podiatric Medical Association. 1996;86(5):224-7.

Jeandrot A, Richard J-L, 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(2):347-52.

Uzun G, Solmazgul E, Curuksulu H, Turhan V, Ardic N, Top C, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. The Tohoku journal of experimental medicine. 2007;213(4):305-12.

Massara M, De Caridi G, Serra R, Barillà D, Cutrupi A, Volpe A, et al. The role of procalcitonin as a marker of diabetic foot ulcer infection. International wound journal. 2017;14(1):31-4.

Chuan F, Tang K, Jiang P, Zhou B, He X. Reliability and validity of the perfusion, extent, depth, infection and sensation (PEDIS) classification system and score in patients with diabetic foot ulcer. PLoS One. 2015;10(4):e0124739.

Korkmaz P, Koçak H, Onbaşı K, Biçici P, Özmen A, Uyar C, et al. The Role of Serum Procalcitonin, Interleukin-6, and Fibrinogen Levels in Differential Diagnosis of Diabetic Foot Ulcer Infection. Journal of diabetes research. 2018;20(2).

Park JH, Suh DH, Kim HJ, Lee YI, Kwak IH, Choi GW. Role of procalcitonin in infected diabetic foot ulcer. Diabetes research and clinical practice. 2017;128(4):51-7.

Aura Victoria van Asten S, Joseph Geradus Peters E, Xi Y, Alfred Lavery L. The role of biomarkers to diagnose diabetic foot osteomyelitis. A meta-analysis. Current diabetes reviews. 2016;12(4):396-402.

Jafari NJ, Firouzabadi MS, Izadi M, Firouzabadi MSS, Saburi A. Can procalcitonin be an accurate diagnostic marker for the classification of diabetic foot ulcers? International journal of endocrinology and metabolism. 2014;12(1).

Sattar N, Hingorani AD. C-reactive protein and prognosis in diabetes: getting to the heart of the matter. Diabetes. 2009;58(4):798-9.

Wolfe F. The C-reactive protein but not erythrocyte sedimentation rate is associated with clinical severity in patients with osteoarthritis of the knee or hip. The Journal of rheumatology. 1997;24(8):1486-8.

Van Asten SA, Nichols A, La Fontaine J, Bhavan K, Peters EJ, Lavery LA. The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis. International wound journal. 2017;14(1):40-5.

Redman R, Kerr G, Payne JB, Mikuls TR, Huang J, Sayles H, et al. Salivary and serum procalcitonin and C-reactive protein as biomarkers of periodontitis in United States veterans with osteoarthritis or rheumatoid arthritis. Biotechnic & Histochemistry. 2016;91(2):77-85.

Garofolo L, Ferreira SRG, Miranda Júnior F. Association between peripheral arterial disease and creactive protein in the japanese-brazilian population. Revista do Colégio Brasileiro de Cirurgiões. 2014;41(3):168-75.


  • There are currently no refbacks.