Pentraxin-3 and Interleukin-18: Potential Biomarkers for the Early Diagnosis and Severity Prediction of Diabetic Foot Ulcer

Background/Aim: As the global incidence of diabetes mellitus (DM) rises, diabetic foot ulcers (DFUs) have emerged as a critical complication associated with increased lower-limb amputations, reduced quality of life, and higher mortality rates.Early detection of DFUs is crucial, sparking interest in potential biomarkers.and Pentraxin-3 (PTX-3) are known contributors to inflammation, and recent studies suggest their involvement in diabetic foot events.This study aims to compare IL-18 and PTX-3 levels in type 2 DM (T2DM) patients, with or without foot ulcers (FUs), and healthy controls while exploring their association with DFU diagnosis and severity.Methods: Eighty-four males participated in the study, including 28 patients with T2DM with FUs, 28 T2DM patients without FUs, and 28 healthy controls.Individuals with type 1 DM (T1DM) or any other types of diabetes, those with infectious or other chronic diseases, and inflammation (such as chronic inflammation and autoimmune diseases), were excluded from participation.Serum IL-18 and PTX-3 were examined using the ELISA method.Enzymatic and colorimetric techniques were used to investigate fasting blood glucose (FBG), hemoglobin A1c (HbA1c), creatinine, urea, alanine transaminase (ALT), and the lipid profile. Results:The average serum levels of IL-18 and PTX-3 were higher in cases of DFU compared to both T2DM cases and controls (P < 0.0001), with the highest levels observed in the DFU group.There was a statistically significant difference in FBG, HbA1c, urea, and creatinine between the different studied groups.ROC curve results showed that the IL-18 cut-off value for predicting severity in patients with DFU compared to T2DM without DFU is ≥ 124.0 pg/ml (P < 0.0001).Meanwhile, the PTX-3 cut-off value for predicting DFU in patients with T2DM is > 8.67 ng/ml.The level of IL-18 differed significantly across the different groups based on perfusion, extent, sensation, infection, depth, and nephropathy conditions. Conclusion:The results indicate that PTX-3 is a promising biomarker for predicting DFU, while IL-18 is a valuable biomarker for predicting severity.