Visual Abstract
Lower extremity amputation in persons with diabetes occurs 0.5-1.0% annually. The annual mortality rate in these patients is 22% after amputation. Serum biomarkers have not proven reliable to display severity. The aim was to describe the initial immunologic response of patients with diabetes and a foot infection requiring surgical intervention. Six patients were enrolled who were admitted to the hospital with a diabetic foot infection and an initial evaluation of 30-day outcomes was performed. Serial assessments of innate and adaptive immune cell activation via flow cytometry and function via assessment of IFN-γ and TNF-α production in ELISpot were performed. Of the patients enrolled and surgically closed, all had a wound dehiscence and no patient healed in this 30-day pilot. No patients were re-infected or re-admitted for lower extremity complications. The activation markers HLA-DR and CD11b on myeloid cells were significantly altered after surgical intervention. The functional assay indicated a potential distinction of patient (Patient 1) with severe infection vs. all others. We applied an immunological assessment to display a change of myeloid cell activation after surgical intervention. We observed a trend that the immune status of severe infection in individual patients can be functionally reflected. These pilot data indicate that we may be able to identify the clinical state of patients by activation and functional assessment.
C. B. Bergmann: None. A. R. Hamad: None. C. C. Caldwell: None. P. Crisologo: None.
