CORRELATION OF INCREASED FIBRINOGEN & OXIDATIVE STRESS IN PROGNOSIS OF DIABETIC FOOT ULCER

BACKGROUND: Diabetic foot ulcer has poor prognosis and is a leading cause of amputation. Oxidative stress is associated with the pathogenesis of chronic wounds. Fibrinogen is a prognostic marker of peripheral vascular disease. AIMS: This prospective case-control study was designed to (i) evaluate and compare oxidative stress, protein carbonyl and fibrinogen levels, (ii) assess the correlation of the above parameters with prognosis in diabetic foot ulcer patients and healthy controls and (iii) whether fibrinogen levels can be used as prognostic markers. MATERIAL AND METHODS: The study included 100 diabetic patients (40 diabetic without complication, 40 diabetic foot ulcer grade 1 and 20 grade 2 patients) and 60 volunteer healthy controls. Oxidative stress was evaluated by estimating the amount of oxidant load of lipid peroxides by ferrous oxidation products in xylenol orange assay in conjunction with triphenylphosphine version 2 (FOX2 assay) and protein carbonyl. The antioxidant status level was estimated by ferric reducing ability of serum (FRAP assay). Fibrinogen and glycated hemoglobin was measured using commercial kits. SPSS version 17 was used for statistical analysis. RESULTS: Oxidative stress was higher in diabetic foot ulcer patients compared to non ulcer (p< 0.05) and controls (p< 0.01). Increased oxidative stress and plasma fibrinogen correlated with poor prognosis. CONCLUSION: Increased oxidative stress and plasma fibrinogen are associated with poor prognosis irrespective of glycemic control.