{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:31:31Z","timestamp":1788877891223,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In addition to systemic inflammatory response syndrome (SIRS), various clinical signs, microbiological findings and inflammatory markers could be associated with severe diabetic foot infections (DFI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included a retrospective cohort of 245 patients with DFI treated at San Juan de Dios Hospital in San Jos\u00e9 de Costa Rica. Erythrocyte sedimentation rate (ESR), C\u2010reactive protein (CRP), CRP\/albumin ratio, peripheral blood leucocyte ratios and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system were evaluated. Univariate analysis was carried out between moderate and severe infections. ROC curves were plotted. Cut\u2010off value of inflammatory markers for diagnosing severe infections was established and then dichotomized to be included in a logistic regression model. A score was designed based on its results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Skin necrosis (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01, OR\u00a0=\u00a08.5, 95% CI\u00a0=\u00a03.5\u201320.9), ESR\u00a0&gt;\u00a094\u00a0mm\/h (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01, OR\u00a0=\u00a02.5, 95% CI\u00a0=\u00a01.2\u20135.1), albumin\u00a0&lt;\u00a02.8\u00a0g\/dl (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04, OR\u00a0=\u00a02.0, 95% CI\u00a0=\u00a01.0\u20134.1) and neutrophil\u2010to\u2010lymphocyte ratio (NLR)\u00a0&gt;\u00a04.52 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01, OR\u00a0=\u00a03.3, 95% CI\u00a0=\u00a01.6\u20136.5) were found to be predictive of severe infections. Score &gt;5 had a good diagnosis performance for classifying severe infections. Moderate infections with a score &gt;5 had a worse prognosis than moderate ones.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found an association of necrosis, serum albumin, ESR and NLR values with severe DFI. The presence of these predictive factors of severity in cases of moderate infections was significantly associated with a higher rate of amputations and recurrences, longer duration of antibiotic treatment and longer hospital stays. DFI could be classified as mild, moderate, severe without SIRS and severe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.14648","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T15:11:40Z","timestamp":1626448300000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Clinical, microbiological and inflammatory markers of severe diabetic foot infections"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6307-5040","authenticated-orcid":false,"given":"Javier","family":"Arag\u00f3n\u2010S\u00e1nchez","sequence":"first","affiliation":[{"name":"Department of Surgery Diabetic Foot Unit La Paloma Hospital Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0028-765X","authenticated-orcid":false,"given":"Gerardo","family":"V\u00edquez\u2010Molina","sequence":"additional","affiliation":[{"name":"Diabetic Foot Unit San Juan de Dios Hospital San Jos\u00e9 de Costa Rica Costa Rica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9530-9729","authenticated-orcid":false,"given":"Mar\u00eda Eugenia","family":"L\u00f3pez\u2010Valverde","sequence":"additional","affiliation":[{"name":"Endocrinology and Nutrition Service Juan Ram\u00f3n Jimenez Hospital Huelva Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Arag\u00f3n\u2010Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Surgery Diabetic Foot Unit La Paloma Hospital Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Mar\u00eda","family":"Rojas\u2010Bonilla","sequence":"additional","affiliation":[{"name":"Diabetic Foot Unit San Juan de Dios Hospital San Jos\u00e9 de Costa Rica Costa Rica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Murillo\u2010Vargas","sequence":"additional","affiliation":[{"name":"Diabetic Foot Unit San Juan de Dios Hospital San Jos\u00e9 de Costa Rica Costa Rica"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"e3280","DOI":"10.1002\/dmrr.3280","article-title":"Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Lipsky BA","year":"2020","journal-title":"Diabetes Metab Res 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