Zhonghua Yi Xue Za Zhi. 2026 Oct 13;106(37):4034-4040. doi: 10.3760/cma.j.cn112137-20260411-00981.
ABSTRACT
Objective: To investigate the correlation between peripheral blood inflammatory markers and Wagner grade as well as Interhational Working Group on the Diabetic Foot (IWGDF)/Infections Diseases Society of America (IDSA) infection grade in patients with diabetic foot infection (DFI). Methods: A retrospective analysis was performed on the clinical data of 396 patients with type 2 DFI who were hospitalized at the Ninth Medical Center of PLA General Hospital from January 1, 2021 to December 31, 2023. Patients were classified into grade 2, grade 3 and grade 4 according to Wagner classification, and divided into mild, moderate and severe groups according to IWGDF/IDSA infection classification. The levels of peripheral blood inflammatory markers were compared among patients with different grades. Spearman rank correlation analysis was used to explore the association between inflammatory markers and the two grading systems. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of each inflammatory marker for Wagner grade 4 and severe IWGDF/IDSA infection. Results: Among the 396 DFI patients, 281 were males and 115 were females, with the age of (64.7±11.3) years. According to Wagner classification, there were 58 cases of grade 2, 196 cases of grade 3, 130 cases of grade 4, and 12 cases with missing grading. According to IWGDF/IDSA infection classification, there were 62 mild cases, 218 moderate cases and 116 severe cases. There were statistically significant differences in platelet count (PLT), platelet-to-lymphocyte ratio (PLR), neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), high-sensitivity C-reactive protein (hs-CRP), fibrinogen degradation products (FDP), fibrinogen (FIB), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) among DFI patients with different Wagner grades (all P<0.05). The levels of white blood cell count (WBC), PLT, PLR, neutrophil percentage, NLR, MLR, hs-CRP, FDP, FIB, CRP and ESR were significantly different among patients with different IWGDF/IDSA infection grades (all P<0.05). Spearman rank correlation analysis showed that both grading systems were positively correlated with PLT, PLR, neutrophil percentage, NLR, MLR, hs-CRP, FIB, CRP and ESR, and negatively correlated with FDP (all P<0.05). ROC curve analysis showed that WBC, PLR, NLR, hs-CRP, CRP and ESR had diagnostic value for both severe IWGDF/IDSA infection and Wagner grade 4 (all P<0.001), with under the curve (AUC) ranging from 0.663 to 0.783. The AUC of all indicators for the diagnosis of severe IWGDF/IDSA infection was higher than that for Wagner grade 4 (all P<0.05). Conclusions: The levels of peripheral blood inflammatory markers in DFI patients are closely correlated with the severity of Wagner grade and IWGDF/IDSA infection grade. WBC, PLR, NLR, hs-CRP, CRP and ESR exhibit better diagnostic performance for severe IWGDF/IDSA infection than for Wagner grade 4.
PMID:42855773 | DOI:10.3760/cma.j.cn112137-20260411-00981