Serum growth differentiation factor-15 levels are associated with the severity of diabetic foot ulcer

Aims To assess serum growth differentiation factor-15 (GDF-15) levels in patients with diabetic foot ulcer and to reveal whether any association exists between GDF-15 and the severity of diabetic foot ulcer. Design A cross-sectional study including three age- and sex-matched cohorts comprising 17 patients (7 F, mean age: 52 +/- 7 years) with diabetic foot ulcer (DMf), 17 patients with type 2 diabetes (6 F, mean age: 51 +/- 6 years) with no foot complication (DM), and 20 healthy controls (8 F, mean age: 50 +/- 8 years) (C) was conducted. Results DMf had higher GDF-15 levels, followed by DM and C (GDF-15, median +/- IQR (pg/mL), DMf: 1039 (884-1566), DM: 649 (375-1148), and C: 296 (212-534), p < 0.001). The severity of diabetic foot disease was positively associated with serum GDF-15 (GDF-15, median +/- IQR (pg/mL), Wagner grade 1: 893 (698-1039), Wagner grade 3: 1705 (1348-2197), and Wagner grade 4: 3075 (1974-4176), p for trend = 0.006). In multivariate regression model, only Wagner grade (beta = 0.55, 95% CI (87-753), p = 0.02) was found to be an independent factor affecting serum GDF-15 concentration. Conclusions Serum GDF-15 levels are high in patients with diabetic foot ulcer. The level is higher in more advanced lesions. GDF-15 measurement can have clinical utility in the management of diabetic foot ulcers.