Association between Serum Cystatin C and Diabetic Foot Ulceration in Patients with Type 2 Diabetes: A Cross-Sectional Study.

Jie Zhao,Gangyi Yang,Ziwen Liang,Yanling Zheng,Bing Chen,Lina Zhou,David G Armstrong,Johnson Boey,Yuping Zhang,Wuquan Deng

doi:10.1155/2016/8029340

Abstract

Serum cystatin C (CysC) has been identified as a possible potential biomarker in a variety of diabetic complications, including diabetic peripheral neuropathy and peripheral artery disease. We aimed to examine the association between CysC and diabetic foot ulceration (DFU) in patients with type 2 diabetes (T2D). 411 patients with T2D were enrolled in this cross-sectional study at a university hospital. Clinical manifestations and biochemical parameters were compared between DFU group and non-DFU group. The association between serum CysC and DFU was explored by binary logistic regression analysis. The cut point of CysC for DFU was also evaluated by receiver operating characteristic (ROC) curve. The prevalence of coronary artery disease, diabetic nephropathy (DN), and DFU dramatically increased with CysC (P < 0.01) in CysC quartiles. Multivariate logistic regression analysis indicated that the significant risk factors for DFU were serum CysC, coronary artery disease, hypertension, insulin use, the differences between supine and sitting TcPO2, and hypertension. ROC curve analysis revealed that the cut point of CysC for DFU was 0.735 mg/L. Serum CysC levels correlated with DFU and severity of tissue loss. Our study results indicated that serum CysC was associated with a high prevalence of DFU in Chinese T2D subjects.

Highlights

Diabetes mellitus is a complex metabolic disease that poised huge challenge to healthcare systems across the globe
The severity and prognosis of Diabetic foot ulceration (DFU) have a close relationship with renal insufficiency, peripheral artery disease (PAD), and neuropathy [6], making it possible for early screening and identification of DFU biomarker related to above diseases
There was no significant difference in gender, diabetes duration, smoking, drinking, diabetes hereditary, diabetic peripheral neuropathy (DPN), diabetic retinopathy (DR), SBP, serum uric acid (UA), potassium, total cholesterol (TC), LDL-C, and difference between sitting and supine of TcPO2 in two groups

Summary

Introduction

Diabetes mellitus is a complex metabolic disease that poised huge challenge to healthcare systems across the globe. Despite increased efforts in prevention and improved understanding of the condition, there is still an upward spike in prevalence rate and a paradigm shift towards developing countries in the recent decades [1]. Early diagnosis and appropriate management of DFU play a crucial role in amputation prevention and reduction of mortality in diabetic population. The underlying mechanism of DFU is poorly comprehended with few possible biomarkers associating DFU prediction. A reliable predictive biomarker to identify and diagnose risk for DFU and its potential severity remains elusive yet. The severity and prognosis of DFU have a close relationship with renal insufficiency, peripheral artery disease (PAD), and neuropathy [6], making it possible for early screening and identification of DFU biomarker related to above diseases

Objectives

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Results