Jurnal Penyakit Dalam Indonesia (2018-06-01)

The Role of Clinical Sign and The Added Value of Procalcitonin in Determining The Existance of Infection in The Treated Diabetic Foot Ulcer

  • Andra Aswar,
  • Em Yunir,
  • Anis Karuniawati,
  • Kuntjoro Harimurti

DOI
https://doi.org/10.7454/jpdi.v5i2.184
Journal volume & issue
Vol. 5, no. 2
pp. 54 – 62

Abstract

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Introduction. Roles of the IDSA-IWGDF clinical sign in determining the existence of infection in the treated diabetic foot ulcer is unknown, and it has to be modified. Procalcitonin, a marker that specific for bacterial infection, have benefit in diagnosing infection in the diabetic foot ulcer, but its roles and added value to the clinical sign of infection in determining the existence of infection in the treated diabetic foot ulcer is also unknown. This study aims to determine the ability of modified IDSA-IWGDF clinical sign of infection and procalcitonin in determining the existence of infection in the treated diabetic foot ulcer. Methods. Cross-sectional study based on diagnostic research was done in the diabetic patient with infected foot ulcer that had been treated and hospitalized in RSCM between October 2011-April 2012. The modified IDSA-IWGDF clinical sign of infection (pain, erythema, edema, warm sensation) was applied to the patient, and blood serum was taken for procalcitonin. The predictive value of this two marker was then assigned using ROC. AUC and cut off point with the best sensitivity and specificity was determined compared to the gold standard. Results. Among total of 47 subjects enrolled for the trial, 41 subjects with sustained infection of the diabetic foot ulcer were diagnosed based on quantitative measurement of bacteria (bacterial load) from the ulcer tissue (gold standard). Modified IDSA-IWGDF clinical sign of infection has good prediction of infection for treated diabetic foot ulcer, AUC: 0,744 (95% CI 0,576-0,912) with cut off point ≥ 2 clinical sign of infection (Sn: 41,46%; Sp: 100%; PPV: 100%, NPV: 20%). AUC: 0,642 (95% CI 0,404-0,880) was determined for procalcitonin. Conclusions. Modified IDSA-IWGDF clinical sign of infection has good ability in determining the existence of infection in the treated diabetic foot ulcer. Procalcitonin has no benefit yet in determining the existence of infection in the treated diabetic foot ulcer.

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