Comparison of Procalcitonin Levels in Diabetic Foot Ulcer Infection and Osteomyelitis: A Systematic Review and Meta-Analysis

Abstract

Background

Foot ulcers represent a major complication in patients with diabetes and are often challenging for clinicians. Distinguishing between infected and non-infected diabetes foot ulcers (DFUs) can prevent many irreversible injuries such as inappropriate antibiotic therapy, amputation, and even death. Procalcitonin (PCT) has been proposed in the diagnosis of infection and osteomyelitis in diabetes foot ulcers. The present study aimed to compare PCT levels between patients with and without infected diabetes foot ulcer (IDFU).

Method

This review searched three databases including PubMed, Web of Science, and Scopus to identify all articles reporting PCT levels in two groups of infected diabetes foot ulcer (IDFU) and non-infected diabetes foot ulcer (NIDFU). Quality has been assessed using the NIH tool. The pooled mean difference (MD) of PCT level between groups was estimated by random effect meta-analysis. In addition, The PRISMA 2020 statement has been used to update guidelines for reporting present systematic reviews.

Result

Twenty-three studies were eligible for meta-analysis, of which data from 2412 people was extracted. Pooled estimation of PCT level was significantly higher in IDFU patients compared with NIDFU patients (MD = 0.25 ng/l, 95% CI: 0.14-0.37). According to the meta-analysis results, PCT level was not significantly higher in patients with Osteomyelitis compared with those without Osteomyelitis (MD = 0.59 ng/l, 95% CI: −0.19, 1.38, I²= 98.5%).

Conclusion

Since the results of the present study showed higher PCT levels in patients with IDFU compared to those without, it can be suggested that procalcitonin might be applied as an additional biomarker for the differentiation of NIDFU from IDFU. It needs more evidence to conclude about the role of PCT in terms of osteomyelitis and amputation.