Diagnostic value of presepsin for severe diabetic food ulcers: A prospective observational study

Diabetic food ulcers (DFU) are a significant complication for patients with type 2 diabetes mellitus. Presepsin is a new biomarker that can offer greater specificity in detecting bacterial infection. So, the study assessed its use in predicting amputation risk in patients with DFU at admission. This prospective study had 2 groups: DFU patients and a control group of type 2 diabetes mellitus patients. DFU patients were staged using the Wagner classification. A presepsin test and review of clinical records were conducted at admission. Seventy-eight patients were included, 49 of whom were male (62.8%). Median age was 70. Sixty-three were in the DFU group, 15 in the control group (no DFU). Increased presepsin levels were observed in patients with DFU, along with elevated C-reactive protein (CRP) and white blood cell (P < .001). Patients who underwent amputation procedures had elevated levels of several inflammatory parameters, including procalcitonin, fibrinogen, white blood cell and presepsin, while CRP levels remained unchanged. In regression analysis, the only significant risk factor for severe infection that required amputation was higher Wagner stage. The optimum presepsin cutoff point of ≥ 1020 pg/mL had the highest sensitivity (100%) and specificity (57.1%) for identifying amputation, with an area under the curve of 0.829 (P = .003). In contrast, CRP, procalcitonin and fibrinogen had unsatisfactory diagnostic capability for amputation, with area under the curve values of 0.674, 0.600, and 0.714 (P = .111, P = .359, and P = .050, respectively). Presepsin may serve as an effective marker for severe infection in patients with DFU. Integrating presepsin and clinical score interpretations can predict severe infections requiring amputation.