Can Procalcitonin Help Predict The Severity Of Lower Extremity Infections?

There is yet more data supporting the use of procalcitonin as a marker for lower extremity infection. Meloni, Uccioli and colleagues in Italy recently published a study in the Journal of Diabetes Research evaluating the prognostic role of procalcitonin in patients with diabetic foot infection and critical limb ischemia (CLI).

All 86 patients in this study were treated according to a preset limb salvage algorithm including vascular intervention, debridement, antibiotics and offloading. Upon patient admission, researchers evaluated inflammatory markers, including procalcitonin, but only considered “positive” procalcitonin values greater than 0.5 ng/mL. The study authors classified outcomes as either limb salvage, major amputation or mortality.

Interestingly, positive procalcitonin at the time of admission was an independent predictor of major amputation and mortality in these patients with diabetic foot infection and CLI.

I think that procalcitonin is becoming more and more commonly utilized because of the growing data surrounding it. We are finding that when procalcitonin is elevated, infection is likely more severe. Whether this tool will change how one treats most infections (surgical versus non-surgical, timing of debridement) remains an open question. All else being equal, however, it appears to be helpful as a predictive tool.

In light of the evidence available, podiatrists may want to consider ordering procalcitonin as part of a comprehensive admission workup for diabetic foot infection, especially in patients with CLI.

Dr. Armstrong is a Professor of Surgery at Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s Note: This blog originally appeared at https://diabeticfootonline.com/2019/09/14/procalcitonin-is-a-prognostic-marker-of-hospital-outcomes-in-patients-with-critical-limb-ischemia-and-diabetic-foot-infection-pubmed-ncbi/ . It is adapted with permission from the author.

Reference

1. Meloni M, Izzo V, Giurato L, et al. Procalcitonin is a prognostic marker of hospital outcomes in patients with critical limb ischemia and diabetic foot infection. J Diabetes Res. 2019;4312737. Doi: 10.1155/2019/4312737.