Evaluati̇on of the role of new bi̇omerkers i̇n the prognosi̇s of di̇abeti̇c foot i̇nfecti̇on

Objective: Diabetic foot infection (DFI) is one of the serious and lifethreatening complications of diabetes, and there is a need for effective biomarkers to aid in early diagnosis and prognosis assessment. This study aimed to investigate the relationship between the serum levels of soluble urokinase-type plasminogen activator receptor (suPAR), Pentraxin-3 (PTX-3), and Angiopoietin-like 2 (ANGPTL2) and the severity, duration, and clinical/laboratory parameters of DFI. Materials and Methods: A total of 54 patients with DFI and 51 healthy individuals as the control group were included. The relationships between serum levels of suPAR, PTX-3, and ANGPTL2 and infection duration (acute ≤14 days, subacutechronic >14 days), PEDIS stage, presence of osteomyelitis, classical inflammatory markers (CRP, ESR, procalcitonin), HbA1c, diabetes duration, and lipid profile were analyzed. Results: The levels of PTX3, ANGPTL2, and suPAR were found to be significantly lower in the patient group compared to the control group. A negative correlation was observed between these biomarkers and HbA1c levels. As PEDIS stages progressed, ANGPTL2 and PTX3 levels showed a significant decrease; however, although suPAR levels were higher in the early stages, the differences were not statistically significant. When the relationship between biomarker levels and the duration of diabetic foot infection was examined in five cases with markedly high levels of ANGPTL2, suPAR, and PTX3, four patients were found to be in the acute stage (≤14 days), while one patient was in the subacute-chronic stage (>14 days). However, due to the very limited sample size (n=5), no statistical comparison was performed among these patients. Among the remaining 49 patients, 30 cases (61.2%) were in the subacute-chronic stage (infection duration >14 days), and 19 cases (38.8%) were in the acute stage (≤14 days). Biomarker levels were generally found to be lower in the subacute-chronic group. Conclusion: suPAR, PTX-3, and ANGPTL2 are promising biomarkers for the diagnosis and prognosis of diabetic foot infection. However, biomarker levels should be interpreted in conjunction with factors such as infection duration and stage, metabolic status, glycemic control, and vascular condition. The findings of this study v support the need for a multidimensional approach in the diagnosis and management of DFI. Keywords: Diabetic foot infection, biomarker, suPAR, Pentraxin-3, Angiopoietin-like 2