Are there differences of inflammatory bio-markers between diabetic and non-diabetic patients with critical limb ischemia?
OBJECTIVE
This observational study was undertaken in order to analyse whether any differences could be detected between diabetic and non-diabetic patients with critical limb ischemia (CLI) concerning the inflammatory response.


METHODS
A total number of 259 consecutive patients with CLI were treated between October 2001 and January 2003.


RESULTS
Among the 259 patients, 135 (52%) had diabetes, previously known in 123, and detected during hospitalization in 12. The diabetic patients more often showed gangrene (P<0.05) and infra-inguinal atherosclerosis (84% vs 67%, P=0.001). The patients with diabetes showed a better lipid profile (total cholesterol 4.6 vs 5 mmol/L, P=0.006 and lower LDL-cholesterol (2.7 vs 3.1 mmol/L, P=0.010) despite the same frequency of statin treatment. They showed a higher creatinine (149 vs 117 micromol/L, P=0.0003) than the non-diabetic patients. Of the inflammatory markers, C-reactive protein (CRP) was equally elevated in both groups. Tumor necrosis factor-a (TNF-a) was increased among the diabetic patients (2.6 vs 1.8 pg/mL, P<0.05), and this difference was most evident in those with gangrene. Neopterin was also higher among the diabetic patients (31 vs 21 mmol/L, P<0.01), but CD40L was not different between groups.


CONCLUSIONS
Diabetes mellitus was very common in CLI patients, and more often combined with renal impairment and infra-inguinal atherosclerosis. The inflammatory markers TNF-a and neopterin were elevated in patients with diabetes as compared to non-diabetic patients, but this difference cannot explain why CLI is 10 times more frequent in diabetic patients.
Bertz
L
L
Department of Vascular Diseases Malmö-Lund, Lund University, Malmö University Hospital, Malmö, Sweden.
Barani
J
J
Gottsäter
A
A
Nilsson
P M
PM
Mattiasson
I
I
Lindblad
B
B
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016638:Critical Illness; D003925:Diabetic Angiopathies / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D016898:Interferon-alpha / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007511:Ischemia / Q000097:blood*; D007866:Leg / Q000098:blood supply*; D008297:Male
D015415:Biomarkers; D016898:Interferon-alpha; D015850:Interleukin-6; D002097:C-Reactive Protein