High cystatin C levels predict undesirable outcome for diabetic foot ulcerations

Abstract

OBJECTIVES: Cystatin C is growing to be an ideal indicator for renal function and cardiovascular events. The aim of this study was to investigate the relationship between serum Cystatin C levels and the prognosis of diabetic foot ulcerations (DFU). METHOD: Totally 1012 patients with Type 2 diabetes were recruited and divided into two groups: non-diabetic-foot group (NDF, n = 865, 85.5%) and diabetic foot ulcer group (DFU, n = 147, 14.5%). After 1 year follow-up, the patients with DFU were grouped into healing group (n = 110, 74.8%) and non-healing group (n = 37, 25.2%) according to the clinical prognosis. Clinical characteristics and the impact factors of ulcer healing were compared and analyzed. RESULTS: Compared to the cured group, patients in non-healing group were older, had long diabetic duration and significantly higher serum Cystatin C concentrations in DFU (P < 0.01). Multiple logistical regression analysis revealed that Cystatin C was an independent impact factor for non-healing rate of DFU (b =-1.277, P < 0.01). After adjusting for age, duration, renal function, Cystatin C was still linked with increased risk of undesirable DFU outcome (OR = 7.279, 95% CI: 1.299-40.784, P < 0.05). By dividing patients into quar-tiles according to Cystatin C, a downward trend in healing rate was found with increased quartile of serum Cystatin C, there are significant lower healing rate was found in fourth group which was only 57.9% compared with other three groups (P < 0.01). The oddis ratio (OR) analysis showed that the risk of undesirable outcome of DFU in Quartile 4 increased significantly (OR = 4.554, 95% CI: 3.14-5.12, P < 0.05) compared with that of Quartile 1. ROC analysis further indicated that the optimal cutoff of Cystatin C to predict the poor prognosis of DFU was 1.35 mg/L (P < 0.01) with 79.3% of sensitivity and nearly 62% of specificity. CONCLUSIONS: There is a strong and independent association between serum Cys-tatin C and diabetic foot ulceration prognosis, and Cystatin C > 1.35 mg/L predicts more than 6-fold increased risk of incurable foot ulceration. OBJECTIVES: Recent studies highlight a critical interaction between adipocyte fatty acid binding protein (A-FABP) and cardiovascular disorders. However, relationships between serum A-FABP with subclinical atherosclerosis in normal glucose tolerance subjects remain unknown. The study aimed to evaluate the association of serum A-FABP with carotid intima-media thickness (C-IMT) in a Chinese population with normal glucose tolerance. METHOD: 2253 cardiovascular disease-free participants with normal glucose tolerance aged from 20 to 78 years old (835 men, 1418 women) from the Shanghai Obesity Study were enrolled. Serum A-FABP levels were measured by a sandwich enzyme-linked immunosorbent assay. B-mode ultrasound was used to assess C-IMT. RESULTS: Serum A-FABP level was significantly higher in women than men (P < 0.001). Partial correlation analysis showed that serum A-FABP was associated with C-IMT in men, premenopausal and postmenopausal women after adjusting...

Association Between Cigarette Smoking and Diabetic Foot Healing: A Systematic Review and Meta-Analysis

“…Finally, 18 articles with 5819 random individuals in total included in this study met the inclusion criteria and were enrolled to this meta-analysis. 10,11,[13][14][15][20][21][22][29][30][31][32][33][34][35][36][37][38] The literature review and selection process were minutely demonstrated in a flow diagram (Figure 1).…”

The impact of hyperglycaemic crisis episodes on long-term outcomes for inpatients presenting with acute organ injury: A prospective, multicentre follow-up study

“…Our study also proposed that cystatin C can be used as a predictor of diabetic foot ulcers ( 45 ). Cystatin C not only has a stronger ability than serum creatinine to predict mortality and the development of end-stage renal disease in diabetic patients ( 46 , 47 ) but also has a strong correlation with the poor healing of diabetic foot ulcers ( 48 ) and the risk of cardiovascular disease, which seems to be associated with promoting atherosclerosis through multiple pathways ( 49 ). In this study, cystatin C was found to be not only a predictor of AKI but also an independent factor influencing adverse events after discharge in HCE patients.…”